Chronic Renal Failure 

 

 

Considerations 

 

  • Gastroparesis & risk of aspiration 

  • Dysregulation of volume status, acid-base (metabolic acidosis), & electrolytes(↑ K, ↓ Na, ↓ Ca, ↑ PO4, ↓ glucose,           ↑ triglycerides) 

  • Coexisting diseases & end-organ complications: 

    • Autonomic dysfunction with hemodynamic instability

    • Pulmonary: pulmonary edema from low albumin, ↓ forced vital capacity, atelectasis 

    • Cardiac: LV dysfunction, hypertension, coronary disease, heart failure, pericarditis, pericardial effusion, arrythmias 

    • Hematologic: anemia/thrombocytopenia 

  • Altered pharmacokinetics due to ↓ elimination, acidosis, hypoalbuminemia 

  • Potential difficult IV access

  • Cr > 200 independent risk factor for cardiac complications & mortality 

 

 

Conflicts 

 

  • Hyperkalemia vs. need for emergency surgery/RSI 

  • Hemodynamic instability vs. RSI 

 

 

Goals 

 

  • Optimize electrolytes, volume status, comorbidities 

  • Avoid worsening renal failure (avoid nephrotoxins, maintain adequate volume status) 

  • Coordinate perioperative dialysis if on hemodialysis 

  • If on peritoneal dialysis: consider draining it to optimize respiratory function 

  • Avoid compromising dialysis access (AV fistulas, indwelling IV lines, PD ports) 

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