Kidney transplant anesthesia can be a mentally challenging yet rewarding aspect of the anesthesiologist's job. End stage renal disease (ESRD) patients tend to have a medical history that leads to very complex physiology. In this article we will review the pathophysiology of ESRD, the effects of ESRD on other body systems, and how it effects the perioperative management of the ESRD patient.

Patients treated with Clopidogrel are usually instructed to discontinue treatment for 7 days prior to surgery because of concern for excessive peri-operative blood loss. Limited data exist regarding blood loss resulting from continuing treatment with Clopidogrel. Our goal was to compare peri-operative blood loss in Clopidogrel (CC) treated patients with Non-Clopidogrel (NC) patients undergoing upper extremity dialysis access surgery. Methods: Following informed consent, 23 patients, 18-90 years old were enrolled in a pilot, prospective study. Nine patients continued treatment with Clopidogrel, while 14 patients had no exposure to the drug. Vascular fistula or graft placement was accomplished under brachial plexus anesthesia and sedation. ADP (adenosine diphosphate) induced inhibition of platelets was assayed by Impedance-based Whole Blood Platelet Aggregation (IWBPA) on immediate preoperative blood sample obtained from all participants to determine baseline platelet aggregation status (Figure 1). Intra-operative blood loss (IBL) was estimated from suction canister output and sponge weights. Interventions such as blood or blood product transfusion were noted. Postoperative bruising or bleeding for up to 24 hours was recorded.