Perioperative Management of Chronic Kidney Disease Patients

Perioperative care of patients with chronic kidney disease (CKD) demands careful balance between the unique risks posed by impaired renal function and the requirements of safe surgery. Preoperative assessment centres on accurate estimation of glomerular filtration rate, optimisation of haemodynamic status, correction of anaemia and electrolyte abnormalities, and adjustment of concomitant medications. Timing of dialysis in end-stage cases must be coordinated to ensure euvolaemia without precipitating intradialytic hypotension. Intraoperative management emphasises tailored anaesthetic techniques, vigilant haemodynamic monitoring and judicious fluid administration to avoid both hypovolaemia and volume overload. Advanced monitoring modalities, including invasive arterial and cardiac output measurement, may be indicated in high-risk procedures. Postoperative care involves close surveillance of renal function, timely dialysis when indicated, stringent infection prophylaxis and thromboprophylaxis, and early recognition of complications such as pulmonary oedema or acute kidney injury. A multidisciplinary team—comprising nephrologists, anaesthetists, surgeons, pharmacists and specialist nurses—facilitates individualised risk stratification and recovery planning. Globally, improved perioperative protocols for CKD patients have been shown to reduce morbidity, shorten hospital stay and lower health-care costs, underscoring the practical impact of integrated care pathways and shared decision-making.

Research from Nature Portfolio

A large retrospective analysis of patients undergoing laparoscopic procedures has revealed a non-linear association between preoperative estimated glomerular filtration rate (eGFR) and postoperative pulmonary complications. Patients with both markedly reduced and supranormal eGFR values experienced higher rates of respiratory adverse events, even after adjustment for comorbidities. These findings have prompted calls for enhanced preoperative cardiovascular and pulmonary assessment and for refinement of fluid-management algorithms across the full spectrum of renal function.

Perioperative Management of Chronic Kidney Disease Patients publication trend

The graph below shows the total number of articles in perioperative management of chronic kidney disease patients across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic Kidney Disease (CKD): Progressive reduction in kidney function over months or years, staged according to estimated glomerular filtration rate.

Estimated Glomerular Filtration Rate (eGFR): A calculated index of renal filtration capacity, derived from serum creatinine, age, sex and ethnicity.

Hemodialysis and Peritoneal Dialysis: Renal replacement therapies that remove waste products and fluid, differing by vascular access and dialysis membrane.

Perioperative Fluid Management: Strategies to maintain optimal intravascular volume and electrolyte balance before, during and after surgery.

Postoperative Pulmonary Complications (PPCs): Respiratory events such as pneumonia, pulmonary oedema or respiratory failure occurring after surgery, influenced by fluid status and anaesthetic technique.

References

1. Postoperative mortality in patients on chronic dialysis following elective surgery: A systematic review and meta-analysis. PLOS ONE (2020).
2. Morbidity after elective surgery in patients on chronic dialysis: a systematic review and meta-analysis. BMC Nephrology (2021).
3. Association of pre-operative estimated GFR on post-operative pulmonary complications in laparoscopic surgeries. Scientific Reports (2017).
4. Clinical and financial impact of chronic kidney disease in emergency general surgery operations. Surgery Open Science (2022).