Chronic kidney disease (CKD) poses a multifaceted challenge, often necessitating surgical interventions for various medical issues, vascular access, and comorbid conditions. CKD patients experience heightened morbidity and mortality rates, prompting accurate perioperative management strategies. Increased bleeding must be considered during surgery and perioperative periods due to uremic platelet dysfunction. Wise management of red blood cell transfusions is crucial for minimizing the risk of antibody formation and potential obstacles to successful renal transplantation. Cardiovascular disease stands out as the primary cause of mortality in this patient group, emphasizing the necessity for thorough cardiovascular risk management strategies. Geriatric surgical outcomes introduce further complexity, influenced by a myriad of factors, including multiple comorbidities, reduced functional status, weakness, and cognitive decline. A multidisciplinary approach is indispensable in these patients in order to supply a good clinical perioperative management of elderly patients. This chapter will attempt to highlight the most common clinical problems, offering tailored recommendations to optimize care management. These recommendations advocate for the seamless integration of expertise across surgical, anesthetic, nephrological, and other pertinent specialties, adaptable to the dynamic phases of care and patient-specific needs. By embracing this collaborative paradigm, health care providers can enhance perioperative outcomes and elevate the standard of care for CKD and elderly surgical patients alike.