Abstract:
:Dialysis-dependent chronic kidney disease (CKD) is an expanding problem for healthcare systems worldwide. The prevalence of end-stage renal disease (ESRD) has increased by 20% since 2000 and stands at 1699 per million people in the USA. ESRD is associated with an increased risk of cardiovascular comorbidity, increased severity of cardiovascular disease, and an adjusted all-cause mortality rate that is 6.4-7.8-fold higher than the general population. These patients may present electively or emergently for surgery related to, or remote from, the CKD. In any perioperative setting, the patient with hemodialysis-dependent CKD represents a significant clinical challenge, and successful management of these patients requires effective cooperation and communication between nephrology, anesthesia, and surgical staff. The ESRD patient's nephrologist will have the best knowledge of their medical history, comorbidities, and future management goals and may have been the clinician who instigated the referral for the surgery, e.g., for parathyroidectomy, vascular access surgery, nephrectomy or renal transplantation. As such, they are in an ideal position to contribute to, or coordinate, early preoperative medical optimization of the patient and also to provide advice during postoperative recovery and rehabilitation. In this article, we provide an overview of some of the key aspects of managing these patients successfully during the perioperative period. We propose the integration of cardiopulmonary exercise testing and cardiovascular optimization into the care of these high-risk patients and provide an overview of the importance of maintaining microvascular perfusion and the role of viscosity in preserving the capillary perfusion network.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Trainor D,Borthwick E,Ferguson Adoi
10.1111/j.1525-139X.2011.00856.xsubject
Has Abstractpub_date
2011-05-01 00:00:00pages
314-26issue
3eissn
0894-0959issn
1525-139Xjournal_volume
24pub_type
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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journal_title:Seminars in dialysis
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pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
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pub_type: 杂志文章,评审
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journal_title:Seminars in dialysis
pub_type: 社论
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journal_title:Seminars in dialysis
pub_type: 杂志文章
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journal_title:Seminars in dialysis
pub_type: 杂志文章,随机对照试验
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