Objective To investigate the relationship between intraoperative central venous pressure(CVP)and postoperative acute kidney injury(AKI)in off-pump coronary artery bypass grafting(OPCABG).Methods A retrospective analysis was conducted,collecting clinical data from patients who underwent OPCABG at the General Hospital of Northern Theater Command of the Chinese People's Liberation Army between 2018 and 2021,and at the Second Affiliated Hospital of Dalian Nedical University between 2019 and 2022.Preoperative,intraoperative,and postoperative data were gathered using electronic medical record and anesthesia systems.The patients were divided into two groups according to whether AKI occurred within 7 days after surgery:AKI group and non-AKI group.The receiver operating characteristic(ROC)curve of intraoperative average CVP and postoperative AKI was plotted to determine the optimal cut-off value of intraoperative average CVP.Multivariate logistic regression analysis was used to assess the corre-lation between intraoperative average CVP and postoperative AKI.Results AKI occurred in 400 patients(34.9％).Compared with the non-AKI group,the age was older(P＜0.05),the BMI and serum creati-nine levels,the proportion of insulin therapy among patients with preoperative hypertension and diabetes,the average CVP,and the incidence of acute hypotensive episodeswas higher(P＜0.05),the intraoperative urine output was significantly reduced(P＜0.05),and the duration of hypotension was lon-ger(P＜0.05)in the AKI group.After fully adjusting for demographics,preoperative comorbidities,and intraoperative variables such as medication use and other covariates,each 1 mmHg increase in intraoperative average CVP was associated with a 1.47-fold increase in the odds of developing AKI(OR=1.47,95％CI 1.36-1.59,P＜0.001).The ROC curve identified 10.11 mmHg as the optimal cutoff value for intraopera-tive average CVP.Patients with an intraoperative average CVP≥10.11 mmHg had a 4.14-fold higher risk of developing postoperative AKI compared to those with CVP＜10.11 mmHg.Conclusion Elevated intrao-perative average CVP(≥10.1 mmHg)is independently associated with a higher risk of postoperative AKI in OPCABG.