The population of patients with chronic kidney disease (CKD) in the United States is progressively increasing, with hemodialysis (HD) as the leading chronic renal replacement therapy. Comorbidities, fluid and electrolyte imbalances, current and future vascular access sites, HD schedules, and continuity of care are some of the special issues that must be considered when delivering perianesthesia care to this patient population. This article will focus on the special issues of the CKD patient and end-stage renal disease patients receiving HD in the perianesthesia setting.