Postoperative Monitoring: Patients with end-stage renal disease are at increased risk of postoperative complications, including fluid overload, electrolyte imbalances, and delayed recovery from anesthesia. Close monitoring of vital signs, electrolytes (especially potassium), and acid-base balance is essential in the immediate postoperative period. Patients should be observed for signs of respiratory depression, particularly if opioids have been used, as the clearance of these drugs may be delayed.
Pain Management: Analgesia must be carefully managed in ESRD patients to avoid drug accumulation and toxicity. Short-acting opioids such as remifentanil, which undergoes metabolism independent of renal function, are preferred during the intraoperative period. Postoperatively, non-opioid analgesics such as acetaminophen should be used as first-line agents, while non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided due to their nephrotoxic potential.
Postoperative Dialysis: Depending on the timing of the last dialysis session and the patient’s postoperative condition, dialysis may be necessary to manage fluid balance, correct hyperkalemia, or remove accumulated anesthetic agents. Hemodialysis should be performed with close attention to hemodynamic stability, as rapid shifts in fluid and electrolyte balance can exacerbate postoperative complications.
