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All patients undergoing surgery or endoscopic procedures should be asked about the use of GLP-1 RAs and GLP-1/GIPRAs Patients should be involved in the discussion and planning regarding the risk of aspiration Cessation of GLP-1 RAs and GLP-1/GIPRAs is NOT recommended due to the risk of hyperglycaemia and compromised weight control Patients should be asked about the use of other medications and/or medical conditions that may exacerbate GI symptoms, such as bowel dysmotility, gastroparesis and Parkinson's disease Pre-procedure diet recommendations are 24-hour clear fluid diet, followed by standard 6 hour fasting time For patients who are not adequately fasted, risk mitigation should occur, including: Point of care gastric ultrasound Prokinetic agents such as metoclopramide and domperidone Modification of anaesthesia Deferral of procedure where possible For perioperative nurses, it is critical to stay up to date with the latest recommendations and guidelines in order to recognise and mitigate risks for our patients in the preoperative phase

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Moreover, inflammation-induced elevation of fibroblast growth factor 23 (FGF23)often heightened in CKDfacilitates erythrocyte apoptosis by suppressing EPO response and raising intracellular ROS levels (Czaya and Faul, 2019