How do you approach consults regarding clearance of patients with chronic kidney disease for surgery?

I never provide "clearance" for surgeries. I comment whether kidney disease is stable and whether there are any contraindications to surgery, medications, etc. based on the kidney disease.

I make sure that kidney function is stable and the medications are appropriate for the surgery/NPO status. Sometimes, I will adjust dosages or hold meds until after surgery. If it is CTS/cardiac cath, then I try to assess the risk for AKI and AKI-requiring dialysis using various scoring systems. It will give me an opportunity to discuss/explain the risks when talking to families.

It is no different than patient with no CKD.

We never asked to provide clearance for surgery, we can provide consultation for someone who has some kidney dysfunction while hospitalized and is going to get cardiac Cath/imaging which needs IV contrasts like iodine-based for CT scans and Gadolinium for MRI.

I recommend fluids for contrast-induced nephropathy prevention, and for Gadolinium with MRI, it depends on what stage of CKD the patient is at already. Usually, Nephrogenic systemic fibrosis risk is there if they have a higher stage of CKD like 3b, 4,5 and patients who are already ESRD on hemodialysis, I usually dialyze them after gadolinium study, although these newer agents do not seem to be associated with NSF.

Otherwise, the general goal is to keep kidney function stable, optimize...