Hemodialysis on the table: Rethinking the Risks

The podcast episode, presented as a monologue, discusses the perioperative management of hemodialysis patients based on a new evidence-based review by Fielding, Singh, and colleagues. It emphasizes that these patients require a fundamentally different approach due to unique physiological challenges, particularly cardiovascular disease, which affects over 75% of them. Key recommendations include performing dialysis the day before surgery, vigilant monitoring of electrolytes (especially potassium and sodium), protecting dialysis access sites, and careful consideration of bleeding risks and medication adjustments. The episode also details specific anesthetic choices and highlights the importance of individualized postoperative management in collaboration with nephrology. The goal is to anticipate and proactively manage risks to ensure safe surgical outcomes for this high-risk patient population.