Chronic kidney disease - NYSORA | NYSORA

Chronic kidney disease

Learning objectives

  • Recognize chronic kidney disease (CKD)
  • Management of CKD

Definition and mechanisms

  • A slow and gradual loss of kidney function over a period of months to years
  • Retention of fluid and waste products
  • Can get worse over time and may lead to kidney failure

Signs & symptoms

Few symptoms in the early stages of CKD 

  • Nausea
  • Vomiting
  • Loss of appetite
  • Fatigue
  • Sleep problems
  • Increased or decreased urination
  • Headaches
  • Muscle cramps
  • Swelling of feet and ankles
  • Dry, itchy skin
  • Hypertension
  • Shortness of breath
  • Chest pain
  • Weight loss
  • Blood in urine

Stages of CKD

CKD stageeGFR (ml/min/1.73m²)Description
1>90Kidney damage with normal GFR
260-89Kidney damage with mildly decreased GFR
330-59Moderately decreased GFR
415-29Severly decreased GFR
5<15Kidney failure


  • Hypertension
  • Diabetes
  • High cholesterol
  • Kidney infection
  • Glomerulonephritis
  • Polycystic kidney disease
  • Heart disease/failure
  • Longterm regular use of lithium or NSAIDs


Cardiovascular systemHypertension
Ischemic heart disease
Heart failure
Respiratory systemPulmonary edema
Pleural effusion
Respiratory infection
Central nervous systemAutonomic neuropathy
HematologicalPerioperative anemia
Bleeding tendency
Gastro-intestinalStress ulcertion
Delayed gastric emptying
Renal and metabolicFluid retention
Metabolic acidosis
Immunological aspectsImmunosuppressant


CKD, chronic kidney disease, dialysis, anemia, hyperkalemia, metabolic acidosis, normovolemia, electrolyte disturbances, propofol, isoflurance, MAP, hypoxia, NSAIDs, aminoglycosides, Vancomycin, cyclosporine, contrast solutions, ARB, CEI, diuretics, furosemide

Keep in mind

  • Decreased renal function can prolong anesthetic drug effects by decreased elimination of these agents

Suggested reading

  • Domi R, Huti G, Sula H, et al. From Pre-Existing Renal Failure to Perioperative Renal Protection: The Anesthesiologist’s Dilemmas. Anesth Pain Med. 2016;6(3):e32386. Published 2016 May 14.
  • Sladen RN. Chronic kidney disease: the silent enemy?. Anesth Analg. 2011;112(6):1277-1279.

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