Anaes · Perioperative medicine
Anaesthesia for renal failure and dialysis
Also known as ESKD anaesthesia · CKD perioperative management · Haemodialysis and surgery · AV fistula precautions anaesthesia · Hyperkalaemia perioperative
Exam-exhaustive anaesthesia for CKD and dialysis: potassium and fluid strategy, dialysis timing, renally adjusted drug dosing, AV fistula protection, uraemic bleeding, haemodynamic goals, and hyperkalaemia crisis management for ANZCA Final and equivalents.
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10 MCQs with explanations
Target exams
Red flags
Meet the patient
A 58-year-old on thrice-weekly haemodialysis with a left radiocephalic fistula arrives for an emergency laparotomy. The potassium taken after last night's dialysis is 5.8 mmol per litre, the ECG shows peaked T waves, and he is dry on the wrong arm. Four questions will decide whether he leaves theatre alive: is the potassium safe, is he over- or under-filled, is the fistula protected, and which drugs and doses.[1]
Hold those four — potassium, volume, access, and drugs — and the whole topic falls into place behind them. The examiner does not want a lecture on nephron segments; they want a practical perioperative plan.[1][2]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Anaesthesia fellowship atlas.
References5Show ledgerHide ledger
- [1]Chowdhury SR, McLure HA Chronic kidney disease and anaesthesia BJA Educ, 2022.PMID 36097571
- [2]Fielding-Singh V, Roshanov PS, Morris AM, et al. Perioperative Management of the Patient Receiving Maintenance Hemodialysis Anesthesiology, 2025.PMID 40923826
- [3]Ayach T, Nappo RW, Paugh-Miller JL, Ross EA Postoperative hyperkalemia Eur J Intern Med, 2015.PMID 25698564
- [4]Nasr R, Chilimuri S Preoperative Evaluation in Patients With End-Stage Renal Disease and Chronic Kidney Disease Health Serv Insights, 2017.PMID 35185335
- [5]Prowle JR, Forni LG, Bell M, et al. Postoperative acute kidney injury in adult non-cardiac surgery: joint consensus report of the Acute Disease Quality Initiative and PeriOperative Quality Initiative Nat Rev Nephrol, 2021.PMID 33976395