Renal impairment significantly increases perioperative anesthesia risk due to altered drug metabolism, fluid balance challenges, electrolyte disturbances, and increased susceptibility to hemodynamic instability. Patients with chronic kidney disease, acute kidney injury, or end-stage renal disease require meticulous anesthesia planning to prevent further renal deterioration and systemic complications.

Kidneys play a critical role in drug elimination and fluid regulation. Impaired renal function affects the clearance of anesthetic agents, muscle relaxants, and pain medications, increasing the risk of prolonged drug effects and toxicity. Electrolyte abnormalities such as hyperkalemia or metabolic acidosis further complicate anesthesia management and may precipitate cardiac arrhythmias.

Pre-anesthesia assessment focuses on identifying the stage of renal disease, dialysis requirements, urine output, electrolyte status, and associated comorbidities such as hypertension, diabetes, and cardiovascular disease. Timing of dialysis relative to surgery is carefully coordinated to optimize fluid and electrolyte balance.

Intraoperative management emphasizes maintaining adequate blood pressure and renal perfusion. Hypotension, dehydration, and nephrotoxic medications are avoided whenever possible. Fluid administration is precisely balanced to prevent overload while ensuring adequate circulation.

Postoperative care includes close monitoring of urine output, kidney function, and electrolytes. Pain management strategies favor drugs with minimal renal excretion. Early detection of renal deterioration allows prompt intervention and reduces progression to severe kidney injury.

With individualized planning and multidisciplinary coordination, anesthesia can be safely delivered to patients with renal impairment while minimizing perioperative complications.