Emergency abdominal surgery in patients with chronic kidney disease

Emergency abdominal surgery in patients with chronic kidney disease (CKD) represents a challenge for the surgical team due to the pathophysiological alterations associated with renal failure. These patients have a higher risk of perioperative complications and a lower physiological reserve to tolerate surgical trauma and anesthesia.1 The degree of renal failure and the use of dialysis also affects the outcome and subsequent morbidity.2 Before surgery, it is essential to perform a comprehensive evaluation of the patient with CKD.3 Key aspects to consider include determining the glomerular filtration rate (GFR) and serum creatinine and urea levels; identifying imbalances such as hyperkalemia, hyponatremia, or metabolic acidosis; evaluating blood volume and blood pressure to prevent episodes of intraoperative hypotension; reviewing the presence of anemia, coagulation disorders, and platelet dysfunction, which are common in CKD; and adjusting or discontinuing drugs that may impair renal function. In patients with advanced stages, assessing the need for a preoperative dialysis session to optimize metabolic balance is crucial.