Uremia, primarily caused by chronic kidney disease (CKD), is a systemic disease affecting various organ systems and leading to metabolic imbalances, cardiovascular complications, and immune dysfunction. These factors increase the risk of adverse outcomes during and after surgery. A preoperative risk stratification, particularly assessing cardiovascular status and fluid balance, is useful given the high prevalence of cardiovascular diseases and other comorbidities in CKD patients. Currently available risk prediction models and their limitations should be carefully considered, as they may further enhance clinical decision making and inform preoperative planning in this population. To mitigate the impact of surgery and minimize complications in the postoperative period, proper timing of preoperative dialysis is crucial for managing electrolyte imbalances, fluid overload, and uremic toxin buildup.