The patient with renal disease

The incidence of chronic renal failure is increasing throughout the world. The perioperative management of patients with chronic kidney disease (CKD) is complicated by both the underlying renal dysfunction, with associated disturbances of fluid and electrolyte homeostasis and altered drug clearance, and the presence of associated comorbid conditions. Preoperative assessment for these complex patients requires multidisciplinary approach from anaesthetic, surgical and nephrology teams. Preservation of normal physiology along with prevention of further kidney injury are central to the management of patients with CKD. This article focuses on the perioperative care of patients, including pharmacological considerations of common medications used.