Although chronic dialysis improves live expectancy, kidney transplantation improves the quality of life. Therefore, kidney transplantation has now become a commonly performed and standardized surgical procedure. Patients with endstage renal disease but with otherwise normal life expectancy are good candidates for this procedure. The tolerable ischemic time for kidneys is up to 48 h, and therefore cadaveric kidney transplants are semi-elective procedures, while living-related kidney transplants are elective.
Renal failure ultimately results in the uremic syndrome: these patients are unable to regulate their volume status and composition of body fluids, leading to fluid overload, metabolic acidosis, and hyperkalemia. In addition, there is secondary organ dysfunction with neuropathy, anemia, platelet dysfunction, hypertension, congestive heart failure, pericardial or pleural effusions, muscle weakness, osteodystrophy, nausea, vomiting, and impaired cellular immunity.
Candidates for renal transplantation usually have end-stage renal failure. However, with the advent of living-related kidney transplantation, some of the recipients may have pre-terminal renal disease that does not yet require dialysis. When the patient is treated with dialysis, it is important to determine the volume status and electrolyte concentrations immediately preoperatively.
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