End Stage Renal Disease (ESRD): What to Expect

End-stage renal disease (ESRD), sometimes referred to as end-stage kidney disease or kidney failure, can bring significant challenges for individuals and their families. In this advanced stage, individuals can expect a range of symptoms and complications. Symptoms of end-stage renal disease may include decreased urine output, fluid retention leading to swelling, fatigue and weakness, loss of appetite and weight changes, difficulty concentrating and confusion, and changes in urine characteristics. These symptoms can have a profound impact on daily life and overall well-being. The physical and emotional toll can be overwhelming for both the individual and their loved ones.

During this difficult time, hospice care offers valuable support to individuals with end-stage renal disease and their loved ones. Hospice teams specialize in managing the physical and emotional challenges associated with advanced kidney failure. They provide expert symptom management to alleviate discomfort and improve quality of life. This includes addressing fluid retention, fatigue, pain, and other distressing symptoms through medication adjustments, dietary modifications, and supportive therapies. Additionally, hospice professionals offer emotional support, counseling, and guidance to help individuals and families cope with the challenges, uncertainties, and changes that arise during this stage. They work closely with the patient’s healthcare providers, ensuring seamless coordination and comprehensive care.

Hospice care also extends support to family members, providing respite care, bereavement services, and assistance with practical matters. By addressing the physical, emotional, and practical needs of individuals with end-stage renal disease, hospice helps enhance their comfort, dignity, and overall quality of life. Hospice teams are dedicated to providing compassionate care and ensuring that individuals and their families receive the support and resources they need throughout this challenging journey.

Hospice Eligibility Guidelines for Individuals Kidney Failure or End-Stage Renal Disease (ESRD)

We understand that navigating the complexities of hospice care can be overwhelming, especially when dealing with end-stage renal disease. This page aims to provide you with a comprehensive guide to the eligibility guidelines for hospice care specifically designed for individuals facing end-stage kidney disease.

Disease Specific Guidelines

Patients who meet the following criteria will be deemed to be in the terminal stage of renal disease, with a life expectancy of six months or less if the illness runs its course.

Chronic Renal Failure: Criteria 1 along with either criteria 2 or 3 should be present to determine hospice eligibility. Criteria 4 serves to lend supporting documentation of terminal status.

  1. The patient is not seeking dialysis or is discontinuing dialysis and is not seeking kidney transplant
  2. Serum creatinine >0mg/dl (>6.0mg/dl for those with diabetes)
  3. Creatinine clearance GFR < 15mL/min
  4. Signs and symptoms of renal (kidney) failure:
    1. Oliguria (decreased urine output)
    2. Uremia (Raised level of urea in the blood) which may lead to itching, nausea and vomiting, confusion, and restlesness
    3. Intractable hyperkalemia (high potassium level) > 7.0 despite treatment
    4. Uremic pericarditis
    5. Hepatorenal syndrome
    6. Intractable fluid overload despite treatment

Acute Renal Failure: Criteria 1 along with either criteria 2 or 3 should be present to determine hospice eligibility. Criteria 4 serves to lend supporting documentation of terminal status.

  1. The patient is not seeking dialysis or is discontinuing dialysis and is not seeking kidney transplant
  2. Serum creatinine >0mg/dl (>6.0mg/dl for those with diabetes)
  3. Creatinine clearance GFR < 15mL/min
  4. Presence of any of the conditions below:
    1. Use of ventilator (mechanical ventilation)
    2. Cancer or malignancy in another organ system
    3. Advanced cardiac disease
    4. Sepsis
    5. Advanced liver disease
    6. Chronic lung disease
    7. AIDS
    8. Immunosuppressed status
    9. Gastrointestinal bleeding
    10. Cachexia or severe malnutrition
    11. Platelet count < 25,000
    12. Disseminated intravascular coagulation (DIC)

Non-Disease Specific Guidelines

  1. Physiologic impairment of functional status demonstrated by a score < 70% using either:
    1. Karnofsky Performance Status (KPS)
    2. Palliative Performance Score (PPS)
  2. Dependence on assistance for two or more of the following activities of daily living (ADLs):
    1. Feeding
    2. Bathing
    3. Dressing
    4. Toileting
    5. Ambulation (walking/moving)
    6. Transfer


Although not the primary hospice diagnosis, the presence of certain co-morbidities should be considered in determining hospice eligibility, as the severity of these conditions is likely to contribute to a life expectancy of six months or less. These co-morbidities may include:

  • Chronic obstructive pulmonary disease
  • Congestive heart failure
  • Ischemic heart disease
  • Dementia
  • Renal failure
  • Diabetes mellitus
  • Liver disease
  • Acquired immune deficiency syndrome (AIDS)
  • Neurologic disease (CVA, ALS, MS, Parkinson’s)
  • Neoplasia

Disclaimer: Please note that the information provided on this page is intended for general guidance purposes only and should not replace professional medical advice. Each individual’s situation is unique, and eligibility for hospice care should be assessed by qualified healthcare professionals.


Benefits of Hospice Care for Individuals with End-Stage Renal Disease:

Hospice care offers numerous benefits tailored to the specific needs of individuals with ESRD. Some of these benefits include:

1. Pain and Symptom Management: Hospice care focuses on alleviating pain and managing distressing symptoms associated with ESRD.

For those with end-stage kidney disease this may include managing symptoms commonly experienced which may include:

  • Fatigue and weakness
  • Fluid retention and swelling
  • Shortness of breath
  • Decreased urine output
  • Changes in urine characteristics
  • Increased nighttime urination
  • Nutrition changes and loss of appetite
  • Nausea and vomiting
  • Itchiness and dry skin
  • Muscle cramps
  • Restless legs
  • Cognitive decline and trouble concentrating
  • Sleep disturbance
  • Pain

The interdisciplinary team, including physicians, nurses, respiratory therapists, social workers, and chaplains, work together to develop a comprehensive plan that addresses the unique needs of each patient.

2. Medication and Equipment Support: Hospice provides medications and other necessary equipment related to managing the symptoms that may arise with ESRD. This ensures that patients have access to the resources they need to maintain comfort and improve their quality of life. All medications and durable medical equipment related to the terminal condition are covered under the hospice benefit. With ESRD this may include mobility aides, a hospital bed, or additional items determined to be necessary by agreement of the hospice team, patient, and caregivers.

3. Emotional and Psychosocial Support: Hospice care extends support not only to patients but also to their families and caregivers. Helping a loved one with ESRD can be challenging. Social workers and counselors are available to provide emotional support, counseling, and resources to cope with the challenges that arise during this difficult time. The nursing team is available to assist in educating and guiding you through providing the best care to your loved one with end-stage renal disease

4. Skilled Nursing Care: Hospice care includes skilled nursing services provided by specially-trained hospice nurses who have expertise in managing the complexities of ESRD. These skilled nurses assess and monitor the patient’s condition, provide anticipatory guidance based on disease progression, educate the patient and caregivers, manage medications, provide wound care if needed, and collaborate with other healthcare professionals to ensure comprehensive care.

5. Assistance with Activities of Daily Living (ADLs): Nurse aides, also known as certified nursing assistants (CNAs), are an integral part of the hospice team. They provide hands-on assistance with activities of daily living (ADLs), such as bathing, dressing, grooming, and toileting. For individuals with ESRD who may experience fatigue and physical limitations due to disease progression, nurse aides help maintain personal hygiene, promote comfort, and preserve dignity.

6. 24/7 Access to Care: Hospice care offers round-the-clock access to the hospice team, providing peace of mind for patients and their families. This availability ensures that assistance is available whenever it is needed, even outside regular office hours.

7. Spiritual and Bereavement Support: Hospice care acknowledges the importance of spiritual and emotional well-being during end-of-life care. Chaplains or spiritual counselors are available to provide spiritual support, and bereavement services are offered to help families cope with grief and loss after the passing of a loved one.

8. Self-guidance: An individual is allowed to receive care in their preferred setting and have input on their care allowing for an increased sense of comfort.

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Not sure if you or a loved one are eligible to receive hospice care?

Contact the Honor Hospice team for an evaluation to determine if hospice is an appropriate care option.

If you have any questions regarding hospice eligibility guidelines for individuals with end-stage kidney disease, please feel free to contact us. Our compassionate team at Honor Hospice is dedicated to providing information, support, and personalized care during this challenging time.

Take the first step towards compassionate care and learn how hospice can make a difference in your life or the life of your loved one.