A patient with end-stage renal disease on dialysis with diabetes mellitus and hypertension, currently stable. Which ASA class applies?

• A. ASA II
• B. ASA III
• C. ASA IV
• D. ASA V

Answer: (B)

The main idea here is the ASA physical status classification, which rates a patient’s baseline systemic health before anesthesia. End-stage renal disease requiring dialysis represents significant systemic disease, and diabetes and hypertension add to that burden. However, because the patient is currently stable and there is no acute, life-threatening decompensation, this situation fits ASA III: a severe systemic disease that limits activity but is not incapacitating. If the patient were acutely unstable or in ongoing life-threatening distress (for example, severe electrolyte disturbances, decompensated heart failure, or sepsis), it would be ASA IV.