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Perioperative Management Of
Patients With Chronic Kidney
Disease
Hosny S Gabriel, M.D
Clinical Professor Of Anesthesiology
Joan C.
C Edwards SOM
Marshall University , Huntington
West Virginia, USA
1
9/30/2009
Clinical Abnormalities in
Patients with CKD
• Fl
Fluid
id and
d Electrolyte
El t l t Disturbance
Di t b
Hypervolemia and Hypovolemia
Hypernatremia and Hyponatremia
Hyperkalemia
H
Hyperphosphatemia
h h i
Metabolic acidosis
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9/30/2009
Potassium Balance
Hyperkalemia is more common than
hypokalemia but both are associated with
hypokalemia,
cardiac morbidity
Normally, ratio of intracellular to extracellular
K is 40:1 ( 160-4 mmol/L)
Patients with CKD can tolerate K 6-6.5 without
any conduction disturbances
Preoperative K 6mmol/L or greater should be
corrected before surgery
Causes of Hyperkalemia in
Patients with CKD
Acute
cute ac
acidosis
dos s
Rhabdomyolosis ( trauma,major surgery)
Increased catabolism, sepsis
NSAID
Angiotensin-converting enzyme inhibitors
Potassium sparing diuretics
Beta-blockers
Nephrotoxic drugs ( cyclosporine and amino-
glycoside.
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9/30/2009
• Cardiovascular Disturbances
Hypertension
Coronary Artery Disease
Generalized Arteriosclerosis
Congestive Heart Failure
Pericarditis
Cardiovascular Disturbance
4
9/30/2009
Hypertension
Most common CV p
problem in CKD
Patients.
Anemia
Bleeding diathesis
Increased susceptibility
p y to infection
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9/30/2009
• Gasterointestinal Disturbances
Gastritis
Peptic ulcer
Bleeding
Nausea and vomiting
Delayed gastric emptying
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9/30/2009
• Neurologic Disturbances
Encephalopathy
Peripheral neuropathy
Autonomic neuropathy
g , gy and impaired
Fatigue,lethargy p
mentation
Hiccups and muscle cramps
Preoperative Evaluation
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9/30/2009
Anesthesia Consideration
• Dialysis Patient
- Type of dialysis, frequency and most
recent treatment should be known
- Ideal timing for dialysis is the day before
surgery
- Euvolumic with K not higher than 6,
the day of surgery and BUN < 100mg
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9/30/2009
9
9/30/2009
Conclusion
Patients with CKD needs careful
assessment with particular attention to
those with cardiac disease or on dialysis.
10
9/30/2009
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