We report the case of a 71-year-old man with creatinine clearance of 41 mL/min and acute anterior ST-segment elevation who underwent urgent coronary artery bypass grafting. A continuous intraoperative veno-arterial hemofiltration with high volumes of exchange (35 mL/kg/h) was used in a series for a miniaturized extracorporeal bypass system to minimize the inflammatory response and to protect the kidneys of this patient who had preoperative renal dysfunction. The patient had an uneventful postoperative recovery.