Medical management of the dialysis patient undergoing surgery
- Neil S Sanghani, MD
Neil S Sanghani, MD
- Assistant Professor of Medicine
- Vanderbilt University Medical Center
- Ramesh Soundararajan, MD, FACP
Ramesh Soundararajan, MD, FACP
- Clinical Assistant Professor of Internal Medicine
- Midwestern University College of Medicine
- Liza M Weavind, MBBCh, FCCM, MMHC
Liza M Weavind, MBBCh, FCCM, MMHC
- Professor of Anesthesiology and Surgery
- Vanderbilt University Medical Center
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
There are limited published data concerning the optimum medical management of the dialysis patient undergoing surgery. This topic reviews the preoperative evaluation and postoperative management (including pain control).
Issues relating to acute kidney injury after surgery, including renal replacement therapy, are discussed elsewhere. (See "Renal replacement therapy (dialysis) in acute kidney injury in adults: Indications, timing, and dialysis dose" and "Overview of the management of acute kidney injury (acute renal failure)" and "Acute hemodialysis prescription".)
SURGICAL MORBIDITY AND MORTALITY
Dialysis patients have a higher perioperative mortality compared with the non-end-stage renal disease (ESRD) population [1-3]. As an example, in a study of 1157 ESRD patients who underwent repair of abdominal aortic aneurysm, the perioperative mortality was 16 percent for those undergoing open repair and 10 percent for those undergoing endoscopic repair . By contrast, the reported perioperative mortality in the general population is 1 to 5 percent for open repair and approximately 1 percent for endoscopic repair [4-6].
The cause of the increased morbidity and mortality with dialysis may be attributed to a number of factors:
●A high incidence of coronary artery disease and myocardial dysfunction
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- SURGICAL MORBIDITY AND MORTALITY
- ROUTINE DIALYSIS PRIOR TO SURGERY
- MEASURES TO PRESERVE RESIDUAL RENAL FUNCTION PRIOR TO SURGERY
- PREOPERATIVE EVALUATION
- Laboratory testing
- Assessment of access
- Indications for dialysis
- - Hyperkalemia
- Elective surgery
- Nonelective surgery
- - Volume overload
- Anemia status
- Cardiovascular evaluation
- - Beta blockers
- Bleeding diathesis
- - Heparin
- Glycemic control
- Intravenous access
- GENERAL ANESTHESIA
- POSTOPERATIVE MANAGEMENT
- - Opiates
- - Acetaminophen
- - Tramadol
- Preservation of residual renal function
- SUMMARY AND RECOMMENDATIONS