Chronic kidney disease（CKD） is an important risk factor of open heart surgery. In addition, worsening of kidney function after the surgery leads to poor prognosis long-term. It is therefore crucial to protect the kidney function by intensive perioperative management in open heart surgery. In the patients having stage 3-4 CKD, mean arterial pressure needs to be higher than 70 mmHg and cardiac index needs to be greater than 2.4 intraoperatively and postoperatively. Continuous right heart monitoring by Swan-Ganz catheter is useful for this purpose. In the patients having stage 5 CKD, systemic complications need to be thoroughly evaluated preoperatively. Hemodialysis and serum potassium control during the extracorporeal circulation is important to minimize delay of postoperatively recovery. For coronary artery bypass grafting, off-pump approach would be a good option in stage 3-4 and stage 5 CKD patients.