Renal failure, acute fluid balance

Major differences exist between the metabolic, fluid, and electrolyte management of patients with acute versus chronic kidney disease (CKD). For example, positive nitrogen balance is more difficult to achieve in patients with acute renal failure (ARF) due to the increased rate of protein catabolism. Additionally, patients with acute renal failure are more likely to develop hyperglycemia during nutritional support and frequently are dialyzed by modalities that are not used commonly for the patient with end-stage kidney disease (ESKD). Because of these differences, the nutritional management of patients with ARF is discussed separately. 

The anesthetist treating CKD patients is confronted with a number of clinical challenges related to altered drug handling, the production and accumulation of active metabolites and difficulties with vascular access and fluid balance [44]. CKD is a risk factor for serious postoperative complications, such as acute renal failure and cardiovascular complications, which are associated with an increased morbidity and mortality [45]. 

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