The Perioperative Management of the Patient with Chronic Kidney Disease

Patients with chronic kidney disease (CKD) are at higher risk for mortality and adverse outcomes in the perioperative setting. Although surgical procedures in CKD patients are commonly performed, a paucity of research exists on the adequate evaluation and minimization of perioperative risk. Most data are tangential and explore the surgical risk of conditions that are associated with CKD, such as cardiovascular disease or anemia. Some strategies that have been adopted in the management of perioperative CKD patients include avoidance of nephrotoxic medications, analysis, and adjustment of electrolyte and glucose abnormalities, correction of anemia, and careful attention to types and amount of resuscitative fluids. Intraoperatively, the proper use of anesthetics, analgesics, and neuromuscular blocking agents, which exhibit altered pharmacodynamics and pharmacokinetics in CKD patients, can minimize unwanted side effects. Proper attention should be paid to postoperative planning and management, with specific attention paid to reinitiation of home medications, as well as adequate nutrition, mobilization, and discharge strategies.