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

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 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 into these aspects.