The effectiveness of pharmacological agents to pro- vide renal protection during cardiac surgery is un- certain.982 1004 (Level of Evidence: B) See Online Data Supplements 37 to 39 for additional data on CABG and renal dysfunction. Depending on the definition used, the incidence of AKI (defined in various studies as an increase in serum creatinine concentration and/or decrease in calculated glomerular filtration rate of a certain magnitude) after isolated CABG is 2% to 3%, and the incidence of AKI requiring dialysis is 1%.1005 Risks factors for developing AKI after CABG are preoperative renal dysfunction, LV systolic dysfunction, PAD, advanced age, race, female sex, type of surgery, diabetes mellitus requiring insulin, emergency surgery, preoperative intraaortic balloon support, and congestive heart failure or shock.1005 1013 The pathogenesis of postoperative AKI is usually multi- factorial. The identification and effective management of mod- ifiable variables can minimize its occurrence. CPB can lead to renal dysfunction if renal perfusion is not adequately maintained. In addition, CPB leads to a systemic inflammatory response, with the release of 1) inflammatory cytokines (eg, kallikrein, bradykinin), 2) catecholamines, and 3) other hormones (eg, renin, aldosterone, angiotensin II, vasopressin), all of which influence renal function. The effects of hypothermia during CPB on renal function are uncertain. Two RCTs1014,1015 showed no effect of CPB temperature on renal function in patients under- going CABG, whereas a 2010 observational study1016 of 1072 subjects identified a relationship between a CPB temperature 27 C and the development of AKI (OR: 1.66; 95% CI: 1.16 to 2.39; P 0.005). 