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Determining Prognosis: Patients with End-Stage Renal Disease (Reading & Sharing)

The renal system maintains internal homeostasis, which is necessary for metabolism:

  • maintain fluid balance
  • excrete waste products
  • conserve nutrients
  • ensure acid-base balance
  • help regulate glucose levels
  • play a role in hormone secretion which is key to blood pressure regulation.

Criteria indicating terminal prognosis for patients with end-stage renal disease can be as follows:

Patient meets criteria for dialysis and/or renal transplant and refuses. Patient with renal failure on dialysis who chooses to discontinue dialysis. and Lab criteria:

  • Creatinine clearance <10 mL/min (<15mL/min with diabetes)
  • Serum creatinine > 8.0 mg/dl (>6.0 mg/dl with diabetes)

Signs and symptoms on progressive uremia

  • Confusion and obtundation
  • Intractable nausea and emesis
  • Generalized pruritis
  • Restlessness
  • Oliguria: Urine output <400ml /24 hours
  • Intractable hyperkalemia : Serum potassium > 7.0, not responsive to medical management
  • Pericarditis
  • Intractable fluid overload
  • Hepatorenal syndrome

Acute renal failure: Comorbid illness associated with a poor prognosis

  • Mechanical ventilation
  • Chronic lung disease
  • Advanced liver disease
  • Immunosuppression /AIDS
  • Cachexia
  • Age>75 years
  • Gastrointestinal bleeding
  • Malignancy
  • Advanced cardiac disease
  • Sepsis
  • Serum albumin <3.5
  • Platelet count <25,000
  • Disseminated intravascular coagulation (DIC)

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