**1.3 Special anesthetic considerations: chronic vs end-stage renal disease**

For those patients with chronic renal disease but have not yet started hemodialysis. It is important to ask the patients about the volume and regularity of daily urine production with special attention to those who report a recent drop in volume and/ or frequency. This may indicate a recent worsening of their renal function, which may necessitate closer attention to potassium changes or fluid management during the procedure. For those patients already on hemodialysis, it is important to establish when the patient underwent hemodialysis last. Ideally, the patient is expected to have hemodialysis 12 to 24 hours prior to the procedure to facilitate their physiologic status to completely or near completely return to normal at the time of anesthetic administration. Additionally, whether the patient has routine hemodialysis regularity or not is also important since a single session of dialysis may not normalize the patient who does not undergo regular hemodialysis, particularly the fluid status. Similarly, it is important to ask if the patient is well tolerated during the last hemodialysis session. If the patient felt uncomfortable during hemodialysis, the session was not completely terminated, or the patient skipped a regular session because of feeling ill, it may indicate other factors that must be seriously considered. These factors, combined with laboratory abnormalities, may necessitate canceling/rescheduling the procedure.
