**1.1 Pre-anesthesia preparation at anesthesia clinic**

A comprehensive preoperative evaluation is mandatory for safe and effective anesthesia management since chronic kidney disease (CKD) is an independent risk factor for predicting postoperative death and cardiac events [1]. Therefore, the evaluation should be most efficiently done in a pre-anesthesia clinic. It is essential to identify the comorbidities that are common to patients with chronic or end-stage renal disease, including coronary artery disease and hypertension. Once identified, measures and treatments should be initiated to medically optimize these patients to minimize or eliminate the risk of surgery and anesthesia. Current guidelines recommend checking a baseline electrocardiogram (ECG) in those patients who have cardiovascular risk factors or documented cardiovascular disease [1]. Additionally, the patient should be scheduled to have routine hemodialysis. Ideally, hemodialysis should be done one day prior to the surgery. Basic laboratory tests including a complete blood count and metabolic and coagulation panel may also be considered in pre-anesthesia clinics.
