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Preoperative Evaluation in Patients With End-Stage Renal Disease and Chronic Kidney Disease

机译：终末期肾脏疾病和慢性肾脏病患者的术前评估

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Optimal preoperative management of dialysis patients remains challenging. Patients with end-stage renal disease (ESRD) have higher mortality in the perioperative setting compared with non-ESRD patients. However, it is well established that dialysis should be done on the day before surgery. Additional dialysis session prior to surgery does not improve outcomes. All dialysis patients should undergo blood work to check electrolytes and especially serum potassium prior to any surgery. Some medications, including angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and diuretics, should be stopped prior to surgery to minimize hemodynamic changes during surgery. The dialysis access should be carefully examined for any signs of infection. The arteriovenous fistula or graft should be evaluated for patency. Glycemic control in diabetic ESRD and chronic kidney disease patients is very important, and clinicians should be aware of the risk of bleeding and the appropriate analgesics that can be used in dialysis patients in the perioperative setting. In conclusion, preoperative evaluation in patients with ESRD should be a multidisciplinary approach.
机译：透析患者的最佳术前管理仍然具有挑战性。与非ESRD患者相比，终末期肾脏疾病（ESRD）患者的围手术期死亡率更高。但是，众所周知，应该在手术前一天进行透析。手术前进行额外的透析治疗并不能改善预后。在进行任何手术之前，所有透析患者都应进行血液检查以检查电解质，尤其是血清钾。某些药物，包括血管紧张素转换酶抑制剂，血管紧张素受体阻滞剂和利尿剂，应在手术前停止使用，以最大程度地减少手术过程中的血液动力学变化。应当仔细检查透析通道是否有感染迹象。动静脉瘘或移植物应进行通畅评估。糖尿病ESRD和慢性肾脏病患者的血糖控制非常重要，临床医生应意识到出血的风险以及围手术期可用于透析患者的适当止痛药。总之，ESRD患者的术前评估应是多学科的方法。

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