Society of Diabetic Nephropathy Prevention Journal of Nephropharmacology 2345-4202 15 2 2026 07 01 Perioperative challenges in spine surgery among patients with chronic kidney disease e12848 e12848 10.34172/npj.2026.12848 EN Zahra Sahraei https://orcid.org/0000-0002-0178-8624 Seyed Sam Mehdi Hosseininasab https://orcid.org/0009-0008-7775-6443 Karim Moradian https://orcid.org/0009-0001-4922-8343 Journal Article 10.34172/npj.2026.12848 2026 01 03 2026 03 20 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.