Background <p>Coronary artery bypass grafting (CABG) is commonly recommended for patients with severe coronary artery disease (CAD). However, the current literature lacks consensus on whether on-pump or off-pump CABG provides superior outcomes between dialysis and non-dialysis patients.</p> Methods <p>This nationwide retrospective cohort study analysed the demographic and comorbid data of 31,016 participants in Taiwan between January 1, 2006 and December 31, 2015. CAD patients who had undergone CABG were stratified by presence of dialysis and the procedure type into the following four groups: non-dialysis, on-pump; non-dialysis, off-pump; dialysis, on-pump; and dialysis, off pump. Study outcomes included postoperative complications and long-term follow-up.</p> Results <p>Non-dialysis on-pump CABG patients experienced worse postoperative outcomes including higher mortality, longer hospital stays, and increased mechanical ventilation use, compared to non-dialysis off-pump CABG patients. Similar trends were observed between the dialysis on-pump CABG and off-pump CABG groups. Cox regression analysis revealed a lower risk of myocardial infarction (MI) and percutaneous coronary intervention (PCI) but higher mortality among non-dialysis on-pump CABG patients (hazard ratio [HR], 0.911, 0.828, and 1.530; 95% confidence interval [CI], 0.850–0.977, 0.761–0.901, and 1.445–1.621; respectively] compared to non-dialysis off-pump CABG patients. In the dialysis population, on-pump CABG patients showed a higher risk of MI and mortality but lower PCI risk than did dialysis off-pump patients (HR, 1.044, 1.262, and 0.724; 95% CI, 0.824–1.322, 1.107–1.439, and 0.582–0.902; respectively). Five-year Kaplan-Meier analysis revealed similar trends.</p> Conclusions <p>Off-pump CABG was generally associated with better mortality outcomes in both non-dialysis and dialysis populations.</p>