Perioperative Management of Patients Receiving Maintenance Hemodialysis: Anesthetic Considerations, Nursing Care, and Patient Safety – A Scoping Review

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Background: Patients receiving maintenance hemodialysis constitute a high- risk surgical population because dialysis dependence intersects with cardiovascular disease, impaired volume and electrolyte regulation, anemia, altered hemostasis, vascular-access dependence, and altered drug disposition. Evidence relevant to perioperative practice is dispersed across anesthesiology, nephrology, surgery, vascular-access, and nursing literature. Objective: To map the published evidence on perioperative management of adults receiving maintenance hemodialysis, with emphasis on anesthesia, nursing care, dialysis timing, vascular-access protection, postoperative complications, and patient safety. Methods: This scoping review was developed according to the JBI approach for scoping reviews and the PRISMA extension for Scoping Reviews (PRISMA- ScR). The Population–Concept–Context framework included adults receiving maintenance hemodialysis; perioperative anesthetic, nursing, and safety management; and elective or urgent surgical/procedural settings. Searches were designed for PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science, supplemented by citation searching. Eligible evidence included observational studies, clinical trials, systematic reviews, and clinically relevant evidence syntheses. Data were charted by study design, population, perioperative domain, and principal findings. No meta-analysis was planned because the objective was evidence mapping. Results: The mapped literature clustered into six domains: perioperative risk and outcomes; timing and adequacy of preoperative hemodialysis; anesthetic and hemodynamic management; vascular-access preservation; nursing surveillance and cannulation safety; and postoperative monitoring with continuity of dialysis. Large cohort studies consistently reported substantially higher postoperative morbidity and mortality among dialysis- dependent patients. A large US cohort found a dose-dependent association between longer intervals from hemodialysis to surgery and higher 90-day