Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects

Abstract

Chronic kidney disease is one of the leading co-morbidity at present. With the increasing prevalence of diabetes mellitus and hypertension, more and more peoples are developing diabetic and hypertensive nephropathy. As chronic kidney disease patient can present as an asymptomatic stable patient in one end and a multi-organ involved complicated end-stage disease in other ends, their management plan also varies. The serum creatinine levels of as low as 1.5 mg% have been linked to perioperative major cardiac events like myocardial infarction and arrest; these patients poses a challenge to the perioperative team. Moreover, a chance of developing acute kidney injury on the chronic kidney disease is also higher. These patients are also often elderly, with diabetes mellitus and/or hypertension. Therefore, accepting such patient for perioperative care needs systematic and meticulous approach. Preoperative assessment, risk stratification, and optimization play a great role. Both intraoperative and postoperative management needs a tailored approach. The present narrative review is prepared to give the current insight on these aspects.

Abbreviations used: AKI – Acute kidney injury; CKD - Chronic kidney disease; ESRD - End stage renal disease; eGFR: estimated Glomerular Filtration Rate; HD – Hemodilaysis; GFR - Glomerular filtration rate; KDIGO - The Kidney Disease: Improving Global Outcomes, RCRI - Revised Cardiac Risk Index; RRT- Renal Replacement Therapy

Received: 28 Oct 2018
Reviewed: 30 Oct 2018
Corrected: 7 Nov 2018
Accepted: 7 Nov 2018

Citation: Karim HMR, Panda CK, Singha SK. Accepting a chronic kidney disease patient for perioperative management: a narrative review of key aspects. Anaesth Pain & Intensive Care 2018;22 Suppl 1:S29-S38