Presentation (CTI)

OBJECTIVES: Renal complications, particularly acute kidney injury (AKI), remain clinically relevant following coronary artery bypass grafting (CABG). Surgical technique may influence perioperative renal risk, yet comparative data remain heterogeneous. To compare baseline renal function and demographic characteristics between patients undergoing on-pump versus off-pump CABG, to stratify patients into AKI risk categories, and to estimate the relative likelihood of postoperative AKI based on preoperative risk profiles.
METHODS: A retrospective cohort of 350 patients undergoing CABG or mixed cardiac surgery at the Heart Center, University of Pécs (Dec 2023-Sep 2025), was analyzed. Patients were assigned to on-pump (n = 287) or off-pump (n = 63) groups. Baseline demographics, comorbidities, and renal parameters (serum creatinine, eGFR, urea) were compared. AKI risk stratification incorporated age >75 years, diabetes, and baseline eGFR <60 mL/min/1.73 m²; meeting ≥2 criteria indicated high risk.
RESULTS: Demographic characteristics were broadly similar between groups. Pre-existing kidney disease and emergent surgery occurred more frequently in on-pump patients (p = 0.040 and p = 0.002). Baseline renal parameters showed no significant differences, though trends favored the off-pump cohort. High-risk AKI classification was significantly more common in the on-pump group (46.0% vs. 35.0%, p = 0.045), suggesting a higher estimated postoperative AKI incidence.
CONCLUSIONS: Off-pump CABG was associated with a more favorable renal risk profile and a lower estimated susceptibility to postoperative AKI. These results should be interpreted with caution due to baseline imbalances and the lack of observed postoperative renal outcomes. Prospective investigations are warranted to determine whether surgical technique independently affects renal outcomes.