Perioperative challenges in spine surgery among patients with chronic kidney disease

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.