Mitral Valve Disease and End Stage Renal Failure

You are reviewing a 69-year-old man in preadmission clinic. He is booked for a femoral nail exchange in 3 weeks secondary to osteomyelitis and fracture non-union. Post procedure he will be considered for mitral valve surgery. Past Medical History End stage renal failure secondary to diabetic nephropathy Rheumatic mitral valve disease Bioprosthetic aortic valve replacement Hypertension Type 2 diabetes mellitus Osteoporosis Medications Frusemide 500 mg once daily Amlodipine 10 mg once daily Metoprolol 50 mg once daily Aspirin 100 mg once daily Long-acting insulin 40 IU nocte Calcium carbonate 1500 mg with meals Calcitriol 0.25 mcg once daily Epoetin alfa 10,000 IU three times per week Phenoxymethylpenicillin 500 mg twice daily Vital Signs Height 1.74 m Weight 97 kg (dry weight 95 kg) BMI 36 kg/m2 BP 183/89 mmHg HR 77 bpm SpO2 95% on room air Temp 36.8°C