Minimizing perioperative complications in patients with renal insufficiency.

Patients with an elevated serum creatinine or whose serum creatinine levels increase postoperatively, regardless of baseline levels, are at increased risk for elevated mortality. Women have a higher risk from acute renal failure than men at every level of serum creatinine. Acute renal failure confers an increased risk of mortality, chronic renal insufficiency, and postoperative infection independent of other postoperative complications. Preoperative measures to reduce risk of acute renal failure include optimizing volume and solute status, ensuring adequate urine flow, avoiding high doses of diuretics, optimizing hematocrit levels, and avoiding contrast agents.