*1.4.2 Hemoglobin and hematocrit*

Patients with chronic or end-stage renal disease are mostly status of "chronic anemia" due to lower erythropoietin activity as well as the effect of uremic toxic metabolites on bone marrow. Anemia does not need to be corrected routinely since it is well tolerated by patients due to the gradual progression of anemia. There are no definite guidelines regarding the hematocrit level below which blood products should be transfused. However, previous studies have reported increased intraoperative complications in patients with end-stage renal disease and preoperative hematocrit levels ranging from 20–26% [3]. Hemodialysis access surgery itself is usually not a procedure with significant surgical blood loss. Therefore, more flexible criteria may be accepted for transfusion. However, transfusion should be considered if the patient is symptomatic or has significant comorbidities such as history of coronary artery disease and/or cerebrovascular disease beyond specific objective criteria of hemoglobin and hematocrit. It should be noted that transfusion of blood products may increase the patient's potassium level [4] as well as induce antibody formation which may decrease a patient's chances of successful renal transplantation in the future [5].
