Surgical procedures in patients with end-stage renal disease are a high-risk clinical process due to the immunological, hemostatic, and metabolic changes caused by the uremic environment. Factors such as platelet dysfunction, fluid-electrolyte imbalances, chronic inflammation, anemia, and malnutrition increase the risk of bleeding, infection, hemodynamic instability, and delayed wound healing during the perioperative period. Therefore, a comprehensive approach is required, encompassing surgical management, dialysis scheduling, anticoagulation strategies, and multidisciplinary coordination. During the preoperative period, the patient’s volume status, electrolyte balance (particularly potassium), acid-base profile, and hemoglobin level should be optimized. For elective surgeries, dialysis is generally recommended to be scheduled within 24 hours prior to the procedure. Anticoagulation management should be individualized by balancing the risk of bleeding with the need for dialysis. During the perioperative period, fluid management must be carefully planned due to hemodynamic fragility; close monitoring for hypotension, arrhythmia, and tissue hypoperfusion is essential. In the postoperative period, occult bleeding, infection, and wound healing issues must be identified early on. Dialysis scheduling should be adjusted based on the condition of the surgical site and the patient’s clinical tolerance; when necessary, heparin-free or low-dose anticoagulation should be preferred. Nursing care plays a central role in the process through systematic clinical assessment, early detection of complications, maintenance of access sites, aseptic practices, and patient education. Consequently, the implementation of perioperative care for dialysis patients using a personalized and multidisciplinary approach is of critical importance for reducing complications and improving clinical outcomes.