Preoperative eGFR, age, and sex predict early postoperative renal changes in acromegaly

Abstract Objective Acromegaly induces renal alterations. However, early postoperative renal changes following rapid hormonal correction remain unclear. We assessed early postoperative changes in estimated glomerular filtration rate (eGFR) and their associated factors, focusing on preoperative eGFR, age, and sex. Methods We retrospectively analyzed 44 patients with acromegaly who underwent transsphenoidal surgery between 2012 and 2024. We analyzed renal function using preoperative eGFR and changes in eGFR at postoperative day 14 (POD14) relative to preoperative values (ΔeGFR). Patients were stratified by preoperative eGFR (≥ 90 vs. 90 mL/min/1.73 m²), age ( 65 vs. ≥ 65 years), and sex. Multivariate regression analyses were performed to identify factors associated with preoperative eGFR and postoperative changes. Results The eGFR had decreased significantly by POD14, especially among patients with higher preoperative eGFR (ΔeGFR: −27, p 0.0001) and in females. Significant declines in eGFR occurred in both younger and older patients, with greater reductions in younger patients. Among older patients, three exhibited declines in eGFR to 60 mL/min/1.73 m² at POD14. Multivariate analysis revealed an association between female sex and greater reductions in IGF-1 standard deviation scores with larger ΔeGFR. Conclusions To our knowledge, this is the first study to demonstrate that rapid postoperative hormonal reductions in acromegaly are associated with early eGFR declines, particularly in patients with higher baseline eGFR, females, and younger patients. While eGFR declines are modest, patients with advanced age and metabolic comorbidities may be at risk of clinically relevant renal impairment and require careful monitoring.