Surgical Risks and Management in Patients with CKD

Due in part to an aging population as well as improved outcomes in patients with end-stage renal disease, elective surgeries are being performed more frequently in patients with all stages of chronic kidney disease (CKD). Patients in this population are at high risk for adverse perioperative outcomes, including acute kidney injury (AKI), cardiovascular events, and mortality. Jehan Z. Bahrainwala, MD, and colleagues reviewed perioperative optimization in this high-risk population in an In Practice article in the American Journal of Kidney Diseases [2020;75(2):245-255].

The article reviews the literature describing absolute risks associated with common surgeries in patients with CKD as well as patients receiving maintenance dialysis therapy. Perioperative optimization with special risk assessment is discussed, including evaluation of cardiovascular and bleeding risk, management of hypertension, and timing of dialysis. Stratifying risk for AKI, major adverse cardiac events, or other serious complications associated with elective surgeries using predictive risk models is reviewed.

“A multidisciplinary approach with individualized counseling is necessary to counsel the patient with advanced CKD or patients treated with maintenance dialysis considering elective surgery,” the authors said.

Read More: American Journal of Kidney Diseases