Perioperative Care of the Renal Patient

doi:10.1001/archinte.1994.00420150030004

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Vol. 154 No. 15, 8 August 1994

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Perioperative Care of the Renal Patient

Paul S. Kellerman, MD

Arch Intern Med. 1994;154(15):1674-1688.

Abstract

Due to the hormonal and hemodynamic alterations inherent inthe surgical experience, acute renal failure is common duringthe perioperative period. Acute renal failure occurs in 5% ofhospital admissions, and the surgical setting is the secondmost common cause of inpatient acute renal failure. Becausethis setting has the highest mortality for acute renal failure,recognition of high-risk patients is essential for careful monitoringand prophylactic measures. Patients with chronic renal insufficiency,elderly patients, jaundiced patients, diabetics, and those undergoingcardiac or aortic surgery are at greatest risk for perioperativeacute renal failure. Patients with severe chronic renal failureor end-stage renal disease are at significant risk for developmentof complications during the perioperative period, due both torenal and nonrenal reasons. Hyperkalemia, infections, arrhythmias,and bleeding commonly occur in these patients during the perioperativeperiod. This population has a reasonable surgical mortalityfor both general and cardiac surgery, but the extremely highmorbidity warrants careful perioperative monitoring and care.

(Arch Intern Med. 1994;154:1674-1688)

Author Affiliations

From the Division of Nephrology, University of California—Davis Medical Center, Sacramento.

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