The preoperative evaluation of patients with acute kidney failure should encompass Volume status Cardiovascular status Systemic hemodynamics Neurological status Laboratory investigations The development of perioperative or postoperative acute kidney failure is associated with poor outcome of the patients, especially if dialysis is required. Thus, the correct appraisal of the individual patient’s risk to develop acute kidney failure is important to develop and apply potential strategies for prevention. The intraoperative monitoring and management of patients with kidney failure is not fundamentally different from that of general patients; however, it needs to be kept in mind that many anesthetic drugs have altered pharmacokinetics and thus prolonged duration of effects in patients with kidney failure.