Zahra Sahraei
1 
, Seyed Sam Mehdi Hosseininasab
2 , Karim Moradian
3* 1 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 Department of Anesthesiology, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract
Chronic kidney disease (CKD) is a global health concern that significantly complicates the perioperative management of patients undergoing spine surgery. CKD patients face heightened risks due to multisystem involvement, including fluid and electrolyte imbalances, coagulopathy, impaired bone metabolism, increased infection susceptibility, and altered drug pharmacokinetics. This narrative review synthesizes current evidence to delineate the perioperative risks and management strategies for CKD patients undergoing spine surgery. Key areas addressed include anesthesia considerations, fluid and electrolyte management, bleeding and coagulopathy, infection risk, bone quality and instrumentation challenges, acute kidney injury (AKI) incidence and prevention, postoperative outcomes, preoperative optimization, medication adjustments, hemodynamic monitoring, dialysis timing, thrombosis risk, perioperative imaging, and enhanced recovery after surgery protocols. The review of evidence indicates that spine surgery in patients with CKD requires careful, multidisciplinary perioperative management. Individualized optimization, advanced monitoring, and tailored protocols are key to reducing complications and improving outcomes.
Implication for health policy/practice/research/medical education:
Patients with chronic kidney disease (CKD) who undergo spine surgery face significant and complex perioperative challenges. Their care demands a coordinated, multidisciplinary strategy that emphasizes personalized risk assessment, careful management of fluids and electrolytes, customized anesthetic planning, and the application of enhanced recovery protocols. Through thorough preoperative preparation and the use of advanced monitoring, clinicians can reduce complications and improve both immediate and long-term results. Ongoing investigation and refinement of perioperative practices remain vital to meet the specific needs of this high-risk population and to promote safer surgical outcomes.
Please cite this paper as: Sahraei Z, Mehdi Hosseininasab SS, Moradian K. Perioperative challenges in spine surgery among patients with chronic kidney disease. J Nephropharmacol. 2026;15(x):e12848. DOI: 10.34172/npj.2026.12848.