Published in PLOS One on 2026-06-22, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. HealthSignal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Mesafint Amare Kebede, Blen Ayele Mamo, Mesfin Sertse Gebremedhin, Mathilda Worku Chala, Siham Faris Isa, Amare Hailu Ashine, Abdullatif Haji-Ababor Abagojam, Abdulhakim Kemal Duressa, Sudi Temam Aman, Sherefudin Hassen Hussen, Merid Lemma Kebede, Kedir Negesso Tukeni
Source: PLOS One • DOI 10.1371/journal.pone.0351987
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Postoperative renal dysfunction (PORD) is a common and serious complication following major vascular surgery and is associated with prolonged hospitalization, renal replacement therapy, and mortality. However, evidences regarding its incidence and associated perioperative factors in resource-limited settings such as Ethiopia remains scarce.
To determine the incidence, severity distribution, and perioperative factors associated with PORD among patients undergoing major vascular surgery at Tikur Anbessa Specialized Hospital.
A retrospective cross-sectional study was conducted at Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia, between January 2018 and December 2024. A total of 377 adult patients who underwent major vascular surgery were included. Renal outcomes were defined and staged according to the kidney disease: Improving Global Outcomes (KDIGO) criteria. Multivariable logistic regression was performed to identify factors independently associated with PORD. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported.
PORD occurred in 22.5% of patients (95% CI: 18.4–26.9%). Among affected patients, 61.2% had mild dysfunction (Stage 1), 24.7% moderate dysfunction (Stage 2), and 14.1% severe dysfunction (Stage 3). Factors independently associated with PORD included age ≥ 60 years (AOR = 5.99, 95% CI: 3.32–10.80), chronic kidney disease (AOR = 3.49, 95% CI: 1.52–8.03), diabetes mellitus (AOR = 2.37, 95% CI: 1.23–4.57), intraoperative blood loss ≥500 mL (AOR = 4.63, 95% CI: 2.13–10.09), and inadequate urine output (AOR = 2.36, 95% CI: 1.13–4.92).
PORD affected nearly one-quarter of patients undergoing major vascular surgery, with most cases classified as mild dysfunction. Advanced age, chronic kidney disease, diabetes mellitus, excessive intraoperative blood loss, and inadequate urine output were significantly associated with PORD. Enhanced perioperative risk assessment and optimization of comorbidities, and careful intraoperative monitoring may help reduce postoperative renal dysfunction in major vascular surgery patients.
Background
Major vascular surgery involves procedures on large arteries and veins, including aortic aneurysm repair, carotid endarterectomy, and peripheral bypass grafting, which are performed for life-threatening conditions such as aneurysmal rupture, severe carotid stenosis, and limb-threatening ischemia [1,2]. Globally, postoperative renal dysfunction (PORD) is among the most serious complications following vascular surgery, with reported incidence ranging from 20–30% [2–4]. Although most cases are mild, a substantial proportion progress to moderate or severe renal dysfunction, increasing the risk of dialysis, prolonged hospitalization, and mortality [5,6]. These findings highlight the considerable clinical burden and perioperative significance of PORD worldwide.
The development of PORD is multifactorial and involves preoperative, intraoperative, and postoperative contributors. Important preoperative factors include advanced age, hypertension, diabetes mellitus, chronic kidney disease, cardiovascular disease, and impaired baseline renal function [7,8]. Intraoperative contributors such as hypotension, excessive blood loss, prolonged surgery, fluid imbalance, vasopressor use, and reduced urine output may compromise renal perfusion and exacerbate kidney injury [9]. Postoperative complications, including infection, thrombosis, diuretic use, and prolonged hospital stay, may further worsen renal outcomes [10]. Together, these factors demonstrate that postoperative renal dysfunction arises from a complex interaction of perioperative conditions affecting renal perfusion and systemic hemodynamic stability.
Reading this evidence
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© 2026 Mesafint Amare Kebede, Blen Ayele Mamo, Mesfin Sertse Gebremedhin, Mathilda Worku Chala, Siham Faris Isa, Amare Hailu Ashine, Abdullatif Haji-Ababor Abagojam, Abdulhakim Kemal Duressa, Sudi Temam Aman, Sherefudin Hassen Hussen, Merid Lemma Kebede, Kedir Negesso Tukeni. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by HealthSignal. The researchers are the authors of the source study, not members of HealthSignal’s staff.
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