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Medical management of the dialysis patient undergoing surgery

Neil S Sanghani, MD
Ramesh Soundararajan, MD, FACP
Liza M Weavind, MBBCh, FCCM, MMHC
Thomas A Golper, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


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 in adults" and "Acute hemodialysis prescription".)


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 [3]. 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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Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
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