Perioperative Management of Renal Disease, Dialysis, and Transplantation in Arthroplasty Patients

Major surgery in patients with end-stage renal disease (ESRD) has reportedly higher perioperative mortality when compared with the non-ESRD population, with dialysis patients presenting increased morbidity, longer intensive care unit (ICU) stay, and longer hospital stays when compared with patients with normal kidney function. Perioperative management in this population is in turn challenged by difficulties in the fluid and electrolyte balance, bleeding vs thrombotic risk, optimal timing for dialysis, and anesthetic and medication considerations. The focus of this chapter is to review potential areas of conflict between the primary care physician or nephrologist, surgeon, and anesthesiologist, to discuss the preoperative evaluation, including history and physical examination of the dialysis access, blood work needed, complications such as bleeding, and drug dosing in patients with ESRD undergoing maintenance dialysis.