Development of acute renal failure on the background of chronic kidney disease (CKD) increases risk for elevated mortality. Women have higher risk from acute renal failure than men at any level of serum creatinine. Acute renal failure is combined with an increased risk mortality, dialysis dependency, and postoperative infection independent of other postoperative complications. Preventive measures before an operation to reduce risk acute renal failure include optimizing of volume and ensuring of adequate urine flow, avoiding high doses of diuretics, optimizing hematocrit levels, and avoiding of contrast agents. Patients with CKD are at increased risk of cardiovascular disease, even in absence of traditional risk factors, and require careful pre-operative cardiac assessment and perioperative monitoring. Cardiovascular risk assessment should be performed in accordance with American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The pharmacokinetics of many drugs used in anaesthesia management is altered in CKD. Specifically, the opioid analgesics meperidine, pethidin should be avoided, as should many neuromuscular blocking agents whose half - lives are prolonged in renal failure. Special attention needs to be paid to preserving of arteriovenous access patency in the intraoperative management of patients on haemodialysis.
Keywords: chronic kidney disease, end-stage renal disease, dialysis, water-electrolyte imbalance, hyperkaliemia, anaesthesia, opioid analgesics, post - operative complications