Surgery in a chronic renal failure patient carries a substantial higher risk then in normal renal function individuals. This is due to more frequent bleeding and infectious complications, intravascular volume impairments, side effects of anesthesia and others. Development of dialysis technique increased the number of patients receiving treatment for end stage renal disease; their prolonged survival rates, as well as the high percentage of co-morbid conditions will continuously raise the need for surgery in patients with chronic renal failure. The complex and difficult management of these patients requires close cooperation of intensive care specialists and nephrologists, in order to reconcile their frequently opposing views.