If renal function is at risk during CABG, what is a potential management option?

• A. Consider renal replacement therapy if indicated.
• B. All patients should have immediate dialysis.
• C. Renal protection is unnecessary.
• D. Only diuretics are used.

Answer: (A)

Renal function can be challenged during CABG by factors such as reduced kidney perfusion on bypass, inflammation, and other perioperative stresses. When the kidneys are at risk or begin to fail, renal replacement therapy provides definitive support by removing excess fluid, correcting electrolyte and acid-base imbalances, and clearing metabolic wastes. This treatment is applied when there are clear indications—such as low urine output with rising creatinine, fluid overload unmanageable by diuretics, hyperkalemia, metabolic acidosis, or uremic symptoms. It can be delivered as intermittent dialysis or continuous renal replacement therapy in the ICU, depending on the patient’s stability. It’s not used universally for every patient, and relying on diuretics alone cannot substitute for the loss of kidney function or its necessary support.