Perioperative Management of the Patient with Chronic Kidney Disease, Hypertension, or End-Stage Renal Disease

Abstract

Perioperative management of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) may be complicated by alterations in fluid and electrolyte balance, acid–base homeostasis, volume status, and drug metabolism, often occurring in the setting of coexisting comorbidities such as hypertension, cardiovascular disease, and diabetes mellitus. CKD may exist in over 20 million Americans and acts as a “risk multiplier” for morbidity, mortality, and cost in the perioperative period – including orthopedic surgery. This chapter will focus on the perioperative medical and anesthesia management of patients with CKD and ESRD as we highlight the impact of kidney disease patient management. Selected issues related to management of dialysis patients as well as the kidney transplant recipient will be discussed.