Minimizing perioperative complications in patients with renal insufficiency

Development of acute renal failure perioperatively is associated with considerable mortality and often with incomplete recovery regardless of baseline renal function. A thorough evaluation of perioperative risk in patients with renal insufficiency should therefore include an additional assessment of the risk for renal injury that might require dialysis and add to the operative mortality. This article will describe the risk for renal injury, elucidate the mechanisms of injury, review the impact of serum creatinine elevations and changes on operative outcomes, and suggest specific measures to reduce perioperative risk.