Renal Failure, Chronic

Incidence in USA and worldwide: >100 cases of ESRD per million population.

Between NHANES of 1988–1994 and that of 2003–2006, the prevalence of CKD in people 60 y and older jumped from 18.8% to 24.5%.

Racial prevalence: African Americans, ∼200 cases per million; Hispanics, ∼100 per million; Caucasians, ∼50 per million.

Overall periop mortality of pts with ESRD: 4%.

Overall periop morbidity of pts with ESRD: 50% (hyperkalemia, infections, hypotension/Htn, bleeding, dysrhythmias, clotted fistulas).

In recent studies, adjusted HRs for death increased consistently as eGFR fell below 60.0mL/min per 1.73m ² with a plateau and relative decrease in risk as eGFR fell below around 20mL/min per 1.73m ² .

Periop progression from CRI, not requiring dialysis, to dialysis-dependent ESRD.

Hypovolemia and hypokalemia (especially if recently dialyzed)

Hypervolemia, metabolic acidosis, and hyperkalemia (especially if not recently dialyzed)

Autonomic dysfunction (excessive hypotensive responses)

Exaggerated hypertensive responses to noxious stimuli

Prolonged responses to renally excreted drugs and metabolites (e.g., vecuronium, pancuronium, narcotics)

Impaired immune status

Occult CAD

Decreased excretory and other functions of kidneys related to long-standing disease; with dialysis, disease can persist for many years.

Associated with multiple complications of failed renal excretory function, including volume overload, accumulation of products of catabolism (e.g., K ⁺ and hydrogen ions), platelet dysfunction, and side effects of dialytic therapy, including hypovolemia.

Associated with complications of concurrent diseases (e.g., DM, Htn) with increased mortality for MI in those with versus without CRF

Volume status and electrolyte balance related to how recent dialysis has been.

Htn (15% Hispanics; 20% Caucasians; 40% African Americans)

DM (20% Caucasians; 30% African Americans; 37% Hispanics); represents 43.8% of all secondary cases

Glomerulonephritis (12% African Americans; 22% Hispanics; 25% Caucasians)

Other causes: Polycystic disease, collagen-vascular disease, pyelonephritis