| '''1.''' In patients with preoperative [[renal dysfunction]] ([[creatinine clearance]] <60 mL/min), off-pump CABG may be reasonable to reduce the risk of [[acute kidney injury]] (AKI).<ref name="pmid11789787">{{cite journal |author=Ascione R, Nason G, Al-Ruzzeh S, Ko C, Ciulli F, Angelini GD |title=Coronary revascularization with or without cardiopulmonary bypass in patients with preoperative nondialysis-dependent renal insufficiency |journal=[[The Annals of Thoracic Surgery]] |volume=72 |issue=6 |pages=2020–5 |year=2001 |month=December |pmid=11789787 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid16305860">{{cite journal |author=Chukwuemeka A, Weisel A, Maganti M, Nette AF, Wijeysundera DN, Beattie WS, Borger MA |title=Renal dysfunction in high-risk patients after on-pump and off-pump coronary artery bypass surgery: a propensity score analysis |journal=[[The Annals of Thoracic Surgery]] |volume=80 |issue=6 |pages=2148–53 |year=2005 |month=December |pmid=16305860 |doi=10.1016/j.athoracsur.2005.06.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(05)01020-9 |accessdate=2011-12-19}}</ref><ref name="pmid17954051">{{cite journal |author=Di Mauro M, Gagliardi M, Iacò AL, Contini M, Bivona A, Bosco P, Gallina S, Calafiore AM |title=Does off-pump coronary surgery reduce postoperative acute renal failure? The importance of preoperative renal function |journal=[[The Annals of Thoracic Surgery]] |volume=84 |issue=5 |pages=1496–502 |year=2007 |month=November |pmid=17954051 |doi=10.1016/j.athoracsur.2007.05.054 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)01148-4 |accessdate=2011-12-19}}</ref><ref name="pmid19406542">{{cite journal |author=Nigwekar SU, Kandula P, Hix JK, Thakar CV |title=Off-pump coronary artery bypass surgery and acute kidney injury: a meta-analysis of randomized and observational studies |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=54 |issue=3 |pages=413–23 |year=2009 |month=September |pmid=19406542 |doi=10.1053/j.ajkd.2009.01.267 |url=http://linkinghub.elsevier.com/retrieve/pii/S0272-6386(09)00441-7 |accessdate=2011-12-19}}</ref><ref name="pmid17258568">{{cite journal |author=Sajja LR, Mannam G, Chakravarthi RM, Sompalli S, Naidu SK, Somaraju B, Penumatsa RR |title=Coronary artery bypass grafting with or without cardiopulmonary bypass in patients with preoperative non-dialysis dependent renal insufficiency: a randomized study |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=133 |issue=2 |pages=378–88 |year=2007 |month=February |pmid=17258568 |doi=10.1016/j.jtcvs.2006.09.028 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)01762-4 |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| '''3.''' In patients with preexisting renal dysfunction, a delay of surgery after [[coronary angiography]] may be reasonable until the effect of radiographic contrast material on renal function is assessed.<ref name="pmid17888981">{{cite journal |author=Del Duca D, Iqbal S, Rahme E, Goldberg P, de Varennes B |title=Renal failure after cardiac surgery: timing of cardiac catheterization and other perioperative risk factors |journal=[[The Annals of Thoracic Surgery]] |volume=84 |issue=4 |pages=1264–71 |year=2007 |month=October |pmid=17888981 |doi=10.1016/j.athoracsur.2007.05.016 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(07)00993-9 |accessdate=2011-12-19}}</ref><ref name="pmid19969314">{{cite journal |author=Medalion B, Cohen H, Assali A, Vaknin Assa H, Farkash A, Snir E, Sharoni E, Biderman P, Milo G, Battler A, Kornowski R, Porat E |title=The effect of cardiac angiography timing, contrast media dose, and preoperative renal function on acute renal failure after coronary artery bypass grafting |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=139 |issue=6 |pages=1539–44 |year=2010 |month=June |pmid=19969314 |doi=10.1016/j.jtcvs.2009.08.042 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(09)01138-6 |accessdate=2011-12-19}}</ref><ref name="pmid18394443">{{cite journal |author=Ranucci M, Ballotta A, Kunkl A, De Benedetti D, Kandil H, Conti D, Mollichelli N, Bossone E, Mehta RH |title=Influence of the timing of cardiac catheterization and the amount of contrast media on acute renal failure after cardiac surgery |journal=[[The American Journal of Cardiology]] |volume=101 |issue=8 |pages=1112–8 |year=2008 |month=April |pmid=18394443 |doi=10.1016/j.amjcard.2007.12.011 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9149(07)02471-X |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''
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| '''4.''' The effectiveness of pharmacological agents to provide renal protection during cardiac surgery is uncertain.<ref name="pmid19282300">{{cite journal |author=Adabag AS, Ishani A, Bloomfield HE, Ngo AK, Wilt TJ |title=Efficacy of N-acetylcysteine in preventing renal injury after heart surgery: a systematic review of randomized trials |journal=[[European Heart Journal]] |volume=30 |issue=15 |pages=1910–7 |year=2009 |month=August |pmid=19282300 |pmc=2719697 |doi=10.1093/eurheartj/ehp053 |url=http://eurheartj.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=19282300 |accessdate=2011-12-19}}</ref><ref name="pmid11348956">{{cite journal |author=Amar D, Fleisher M |title=Diltiazem treatment does not alter renal function after thoracic surgery |journal=[[Chest]] |volume=119 |issue=5 |pages=1476–9 |year=2001 |month=May |pmid=11348956 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=11348956 |accessdate=2011-12-19}}</ref><ref name="pmid12968238">{{cite journal |author=Caimmi PP, Pagani L, Micalizzi E, Fiume C, Guani S, Bernardi M, Parodi F, Cordero G, Fregonara M, Kapetanakis E, Panella M, Degasperis C |title=Fenoldopam for renal protection in patients undergoing cardiopulmonary bypass |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=17 |issue=4 |pages=491–4 |year=2003 |month=August |pmid=12968238 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S1053077003001551 |accessdate=2011-12-19}}</ref><ref name="pmid18068064">{{cite journal |author=Cogliati AA, Vellutini R, Nardini A, Urovi S, Hamdan M, Landoni G, Guelfi P |title=Fenoldopam infusion for renal protection in high-risk cardiac surgery patients: a randomized clinical study |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=21 |issue=6 |pages=847–50 |year=2007 |month=December |pmid=18068064 |doi=10.1053/j.jvca.2007.02.022 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(07)00056-0 |accessdate=2011-12-19}}</ref><ref name="pmid17198774">{{cite journal |author=El-Hamamsy I, Stevens LM, Carrier M, Pellerin M, Bouchard D, Demers P, Cartier R, Page P, Perrault LP |title=Effect of intravenous N-acetylcysteine on outcomes after coronary artery bypass surgery: a randomized, double-blind, placebo-controlled clinical trial |journal=[[The Journal of Thoracic and Cardiovascular Surgery]] |volume=133 |issue=1 |pages=7–12 |year=2007 |month=January |pmid=17198774 |doi=10.1016/j.jtcvs.2006.05.070 |url=http://linkinghub.elsevier.com/retrieve/pii/S0022-5223(06)01566-2 |accessdate=2011-12-19}}</ref><ref name="pmid12709682">{{cite journal |author=Fansa I, Gol M, Nisanoglu V, Yavas S, Iscan Z, Tasdemir O |title=Does diltiazem inhibit the inflammatory response in cardiopulmonary bypass? |journal=[[Medical Science Monitor : International Medical Journal of Experimental and Clinical Research]] |volume=9 |issue=4 |pages=PI30–6 |year=2003 |month=April |pmid=12709682 |doi= |url=http://www.medscimonit.com/fulltxt.php?ICID=4686 |accessdate=2011-12-19}}</ref><ref name="pmid16083524">{{cite journal |author=Fischer UM, Tossios P, Mehlhorn U |title=Renal protection by radical scavenging in cardiac surgery patients |journal=[[Current Medical Research and Opinion]] |volume=21 |issue=8 |pages=1161–4 |year=2005 |month=August |pmid=16083524 |doi=10.1185/030079905X53289 |url=http://informahealthcare.com/doi/abs/10.1185/030079905X53289 |accessdate=2011-12-19}}</ref><ref name="pmid15809463">{{cite journal |author=Friedrich JO, Adhikari N, Herridge MS, Beyene J |title=Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death |journal=[[Annals of Internal Medicine]] |volume=142 |issue=7 |pages=510–24 |year=2005 |month=April |pmid=15809463 |doi= |url= |accessdate=2011-12-19}}</ref><ref name="pmid17414730">{{cite journal |author=Haase M, Haase-Fielitz A, Bagshaw SM, Reade MC, Morgera S, Seevenayagam S, Matalanis G, Buxton B, Doolan L, Bellomo R |title=Phase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients |journal=[[Critical Care Medicine]] |volume=35 |issue=5 |pages=1324–31 |year=2007 |month=May |pmid=17414730 |doi=10.1097/01.CCM.0000261887.69976.12 |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0090-3493&volume=35&issue=5&spage=1324 |accessdate=2011-12-19}}</ref><ref name="pmid8160980">{{cite journal |author=Ip-Yam PC, Murphy S, Baines M, Fox MA, Desmond MJ, Innes PA |title=Renal function and proteinuria after cardiopulmonary bypass: the effects of temperature and mannitol |journal=[[Anesthesia and Analgesia]] |volume=78 |issue=5 |pages=842–7 |year=1994 |month=May |pmid=8160980 |doi= |url=http://www.anesthesia-analgesia.org/cgi/pmidlookup?view=long&pmid=8160980 |accessdate=2011-12-19}}</ref><ref name="pmid17185146">{{cite journal |author=Landoni G, Biondi-Zoccai GG, Tumlin JA, Bove T, De Luca M, Calabrò MG, Ranucci M, Zangrillo A |title=Beneficial impact of fenoldopam in critically ill patients with or at risk for acute renal failure: a meta-analysis of randomized clinical trials |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=49 |issue=1 |pages=56–68 |year=2007 |month=January |pmid=17185146 |doi=10.1053/j.ajkd.2006.10.013 |url=http://linkinghub.elsevier.com/retrieve/pii/S0272-6386(06)01611-8 |accessdate=2011-12-19}}</ref><ref name="pmid18249327">{{cite journal |author=Landoni G, Biondi-Zoccai GG, Marino G, Bove T, Fochi O, Maj G, Calabrò MG, Sheiban I, Tumlin JA, Ranucci M, Zangrillo A |title=Fenoldopam reduces the need for renal replacement therapy and in-hospital death in cardiovascular surgery: a meta-analysis |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=22 |issue=1 |pages=27–33 |year=2008 |month=February |pmid=18249327 |doi=10.1053/j.jvca.2007.07.015 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(07)00234-0 |accessdate=2011-12-19}}</ref><ref name="pmid11794223">{{cite journal |author=Murphy MB, Murray C, Shorten GD |title=Fenoldopam: a selective peripheral dopamine-receptor agonist for the treatment of severe hypertension |journal=[[The New England Journal of Medicine]] |volume=345 |issue=21 |pages=1548–57 |year=2001 |month=November |pmid=11794223 |doi=10.1056/NEJMra010253 |url=http://www.nejm.org/doi/abs/10.1056/NEJMra010253?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed |accessdate=2011-12-19}}</ref><ref name="pmid19167908">{{cite journal |author=Nigwekar SU, Hix JK |title=The role of natriuretic peptide administration in cardiovascular surgery-associated renal dysfunction: a systematic review and meta-analysis of randomized controlled trials |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=23 |issue=2 |pages=151–60 |year=2009 |month=April |pmid=19167908 |doi=10.1053/j.jvca.2008.11.007 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(08)00353-4 |accessdate=2011-12-19}}</ref><ref name="pmid12620953">{{cite journal |author=Piper SN, Kumle B, Maleck WH, Kiessling AH, Lehmann A, Röhm KD, Suttner SW, Boldt J |title=Diltiazem may preserve renal tubular integrity after cardiac surgery |journal=[[Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie]] |volume=50 |issue=3 |pages=285–92 |year=2003 |month=March |pmid=12620953 |doi=10.1007/BF03017799 |url=http://dx.doi.org/10.1007/BF03017799 |accessdate=2011-12-19}}</ref><ref name="pmid15464494">{{cite journal |author=Ranucci M, Soro G, Barzaghi N, Locatelli A, Giordano G, Vavassori A, Manzato A, Melchiorri C, Bove T, Juliano G, Uslenghi MF |title=Fenoldopam prophylaxis of postoperative acute renal failure in high-risk cardiac surgery patients |journal=[[The Annals of Thoracic Surgery]] |volume=78 |issue=4 |pages=1332–7; discussion 1337–8 |year=2004 |month=October |pmid=15464494 |doi=10.1016/j.athoracsur.2004.02.065 |url=http://linkinghub.elsevier.com/retrieve/pii/S0003497504004643 |accessdate=2011-12-19}}</ref><ref name="pmid20332738">{{cite journal |author=Ranucci M, De Benedetti D, Bianchini C, Castelvecchio S, Ballotta A, Frigiola A, Menicanti L |title=Effects of fenoldopam infusion in complex cardiac surgical operations: a prospective, randomized, double-blind, placebo-controlled study |journal=[[Minerva Anestesiologica]] |volume=76 |issue=4 |pages=249–59 |year=2010 |month=April |pmid=20332738 |doi= |url=http://www.minervamedica.it/index2.t?show=R02Y2010N04A0249 |accessdate=2011-12-19}}</ref><ref name="pmid10735688">{{cite journal |author=Sirivella S, Gielchinsky I, Parsonnet V |title=Mannitol, furosemide, and dopamine infusion in postoperative renal failure complicating cardiac surgery |journal=[[The Annals of Thoracic Surgery]] |volume=69 |issue=2 |pages=501–6 |year=2000 |month=February |pmid=10735688 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0003-4975(99)01298-9 |accessdate=2011-12-19}}</ref><ref name="pmid15983954">{{cite journal |author=Tumlin JA, Finkel KW, Murray PT, Samuels J, Cotsonis G, Shaw AD |title=Fenoldopam mesylate in early acute tubular necrosis: a randomized, double-blind, placebo-controlled clinical trial |journal=[[American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation]] |volume=46 |issue=1 |pages=26–34 |year=2005 |month=July |pmid=15983954 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0272638605004580 |accessdate=2011-12-19}}</ref><ref name="pmid12842858">{{cite journal |author=Vesely DL |title=Natriuretic peptides and acute renal failure |journal=[[American Journal of Physiology. Renal Physiology]] |volume=285 |issue=2 |pages=F167–77 |year=2003 |month=August |pmid=12842858 |doi=10.1152/ajprenal.00259.2002 |url=http://ajprenal.physiology.org/cgi/pmidlookup?view=long&pmid=12842858 |accessdate=2011-12-19}}</ref><ref name="pmid20638862">{{cite journal |author=Wang G, Bainbridge D, Martin J, Cheng D |title=N-acetylcysteine in cardiac surgery: do the benefits outweigh the risks? A meta-analytic reappraisal |journal=[[Journal of Cardiothoracic and Vascular Anesthesia]] |volume=25 |issue=2 |pages=268–75 |year=2011 |month=April |pmid=20638862 |doi=10.1053/j.jvca.2010.04.022 |url=http://linkinghub.elsevier.com/retrieve/pii/S1053-0770(10)00193-X |accessdate=2011-12-19}}</ref><ref name="pmid9594859">{{cite journal |author=Young EW, Diab A, Kirsh MM |title=Intravenous diltiazem and acute renal failure after cardiac operations |journal=[[The Annals of Thoracic Surgery]] |volume=65 |issue=5 |pages=1316–9 |year=1998 |month=May |pmid=9594859 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S000349759800157X |accessdate=2011-12-19}}</ref> ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''}}
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