Chronic kidney disease

Chronic kidney disease (CKD) is a common disorder as currently defined. Patients with CKD face two major hazards: cardiovascular disease and – in a minority – progression to end-stage renal disease (ESRD). Advanced CKD also causes numerous metabolic and other complications. The management of CKD involves excluding acute kidney injury, diagnosing the cause of CKD, slowing progression and detecting and treating complications. Surgeons seeing patients with CKD should aim to optimize fluid balance in the perioperative period, avoid nephrotoxic agents and ensure drug doses are appropriate for the level of renal function. Nephrological input should be sought early if required.