Anaesthesia Challenges in Patients With Chronic Kidney Disease: A Clinical Approach From Internal Medicine

Chronic kidney disease (CKD) poses significant challenges for perioperative anaesthetic management due to complex alterations in drug clearance, fluid and electrolyte balance, and increased cardiovascular risk. Despite growing prevalence, there is a lack of consolidated clinical guidance addressing these issues from an internal medicine perspective. This review aims to comprehensively synthesize current evidence on anaesthetic considerations in CKD patients, focusing on strategies to optimize perioperative care. A thorough literature review was conducted, examining pathophysiological changes, pharmacokinetic alterations, and clinical management protocols relevant to this population. Key findings emphasize the necessity for meticulous preoperative assessment, including evaluation of renal and cardiovascular function and careful medication adjustment to avoid nephrotoxicity. Intraoperative management should prioritize individualised anaesthetic choice, vigilant fluid and hemodynamic monitoring, and prevention of acute kidney injury. Postoperative care involves renal function preservation, tailored analgesia, and infection prevention, with special attention to dialysis and transplant patients. The review underscores the critical role of an interdisciplinary approach integrating nephrology, anaesthesia, and internal medicine. Implementing these strategies can improve perioperative safety and reduce complications. Future research is needed to establish evidence-based guidelines tailored to this vulnerable population.