Patients with established chronic renal failure have a longer life expectancy than they did two or three decades ago. As a result, anaesthetists now provide care for these patients with increased frequency for a variety of surgical procedures. Two important factors contributing to the increased life expectancy are the continuing refinements in dialysis and renal transplantation. The ultimate object of dialysis is to maintain chronic renal failure patients until a suitable donor kidney becomes available for transplantation. The anaesthetist should be alert for signs and symptoms encompassing the clinical spectrum of abnormalities seen in chronic renal failure.