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♦️ Introduction
Your patient with end-stage renal disease is heading to surgery tomorrow. Dialysis was two days ago — now what? Managing these patients isn’t just about timing; it’s a careful balance of volume, electrolytes, and access protection to keep things smooth in the OR.
💧 1. Dialysis Timing
Try to schedule surgery within 24 hours after dialysis, when fluid and electrolyte levels are most stable.
This timing helps reduce hyperkalemia and fluid overload risk.
🧪 2. Preoperative Labs
There’s no universal rule for day-of-surgery labs — but potassium is the MVP here.
Check it if:
- Dialysis was >24 h ago
- The patient missed a session
- It’s a major or urgent case
⚖️ 3. Volume Management
Assess whether they’re “wet” or “dry.”
During anesthesia:
- Go easy on crystalloids
- Prefer vasopressors over fluids for hypotension
- Avoid overcorrection — they can’t excrete extra water
💉 4. Vascular Access Protection
Never use the fistula arm for blood pressure cuffs, IVs, or arterial lines.
Preserving access = preserving life.
💡 Take-Home Message:
- Schedule surgery within 24 h post-dialysis
- Check K⁺ if dialysis timing is off
- Manage volume conservatively
- Protect the access arm
