Hemodialysis is the most common form of renal replacement therapy employed in approximately 4 million patients world-wide. Patients on hemodialysis may need elective or emergent surgery related or unrelated to end-stage renal disease. These patients are at an increased risk of perioperative morbidity and mortality. Successful outcomes require meticulous multidisci-plinary teamwork coordinated by a nephrologist. The scarcity of studies further complicates this task. In this practical guide, we briefly summarize the available data.