Anaesthesia for children with renal disease

Abstract

### Key points Established renal disease is a rare but significant cause of morbidity and mortality in children and has implications for the conduct of general anaesthesia. According to the UK Renal Association, care of these children should be delivered by a team of paediatric specialists, including nephrologists, urologists, surgeons, and anaesthetists.1 Renal transplantation is the preferred treatment for children with chronic kidney disease (CKD) and leads to better quality of life, optimal growth, and longer-term survival compared with dialysis. 80.2% of children receiving specialist care for CKD in 2012 had a functioning renal transplant compared with 50.4% of adults receiving renal replacement therapy (RRT).2 Such children may present anywhere for emergent surgery, thus knowledge of the care of the child with CKD or a renal transplant is necessary for all anaesthetists. Stage of CKD is classified according to the glomerular filtration rate (GFR) which is conventionally indexed to body surface area, therefore the units of ml min−1 (1.73 m2)−1 (Table 1). View this table: Table 1 Classification of CKD3 In 2012, the incidence of CKD requiring RRT in children under the age of 16 was 9.9 per million of the age-related UK population. The steady increase in this number over the past decade appears now to have reached a steady state. The initial …