| Hyperkalaemia | The peri-operative danger — arrhythmia/arrest risk. Check K⁺; dialyse pre-op if elevated; avoid suxamethonium if K⁺ already high (it raises K⁺ by ~0.5 mmol/L); avoid K⁺-rich fluids |
| Anaemia | Chronic, well-compensated (↑ 2,3-DPG, right-shifted ODC) — usually tolerated; avoid unnecessary transfusion (sensitisation before possible transplant) |
| Metabolic acidosis | Reduces protein binding (↑ free drug fraction) and shifts K⁺ out of cells |
| Fluid status | Fluid overload (missed dialysis) or hypovolaemia (over-dialysed, below "dry weight") — assess carefully |
| Uraemic platelet dysfunction | Bleeding tendency (± residual heparin from recent dialysis, and anticoagulants); consider DDAVP if bleeding |