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Anesthesia for the patient on dialysis

Authors
Jeremy P Campbell, MB, ChB (Hons.), MRCS, FRCA
Jonathan M Cousins, BSc, MBBS, FRCA, FFICM
Section Editors
Michael Avidan, MD
Stephanie B Jones, MD
Jeffrey S Berns, MD
Deputy Editors
Nancy A Nussmeier, MD, FAHA
Alice M Sheridan, MD

INTRODUCTION

End-stage renal disease (ESRD) is a growing problem worldwide [1] (see "Epidemiology of chronic kidney disease"). In the United States, >90 and <10 percent of patients with ESRD are receiving hemodialysis and peritoneal dialysis, respectively. Dialysis-dependent patients may require surgery for a predictable variety of reasons, including vascular access procedures, parathyroidectomy, and renal transplantation. Patients may also require elective or emergent surgical procedures for reasons that are unrelated to their ESRD.

This topic reviews the preanesthesia consultation and the anesthetic and immediate postoperative management of dialysis patients. Preoperative medical management of these patients is discussed in detail elsewhere (see "Medical management of the dialysis patient undergoing surgery"). Anesthetic management of dialysis-dependent patients undergoing renal transplantation is discussed separately. (See "Preanesthesia consultation for renal transplant recipients".)

DIALYSIS: FLUID AND ELECTROLYTE MANAGEMENT

General considerations — Hemodialysis and peritoneal dialysis are renal replacement therapies that are used to remove metabolic waste products and excess volume (sodium and water) from circulation and to correct certain acid–base and electrolyte abnormalities. Patients on maintenance hemodialysis will generally have received dialysis 24 to 48 hours prior to elective surgery. Hemodialysis patients undergoing nonelective surgery may have received dialysis up to 72 hours prior to presentation. Patients on peritoneal dialysis generally have daily dialysis that may be continued until just prior to surgery. (See "Medical management of the dialysis patient undergoing surgery", section on 'Routine dialysis prior to surgery'.)

Preoperative anesthetic assessment includes determination of the following details:

Type of dialysis (hemodialysis, peritoneal dialysis)

                                                      

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Literature review current through: Nov 2016. | This topic last updated: Thu Jan 07 00:00:00 GMT 2016.
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