Abstract
Disclosure: K. Tomiyama: None. I. Fukuda: None. M. Okazaki-Hada: None. S. Kobayashi: None. T. Nagamine: None. K. Inagaki: None. M. Nagao: None. S. Tahara: None. M. Iwabu: None. Background: Acromegaly is characterized by renal hypertrophy and glomerular hyperfiltration due to excess of growth hormone (GH) and insulin-like growth factor I (IGF-I), which can potentially lead to renal dysfunction. If the preoperative renal function is not high, or the patient is elderly, there is a possibility that postoperative renal function may decline. The aim of this cohort study was to analyze renal function at diagnosis and its postoperative changes in patients with acromegaly and to investigate clinical parameters influencing renal outcomes, with particular focus on preoperative renal function and age. Methods: This retrospective study included 47 patients with acromegaly who underwent transsphenoidal surgery at our hospital between 2012 and 2024. The changes in estimated glomerular filtration rate (eGFR) before and 14 days after surgery were analyzed. Subgroup analyses were conducted based on preoperative eGFR levels (≥ 90 or < 90 mL/min/1.73 m²) and age (< 65 or ≥ 65 years). Body composition was assessed in 5 cases using a bioelectrical impedance analysis to evaluate muscle mass, body fat, and intra-/extracellular water content. Among patients with eGFR ≥ 90, univariate correlations between ΔeGFR (preoperative eGFR - postoperative eGFR) and pre-/postoperative levels of GH, IGF-I, IGF-I standard deviation score (SDS), BMI, age, comorbidities (diabetes and hypertension) were analyzed. Data are shown as median (IQR). Results: Preoperative eGFR was significantly higher in patients aged <65 years [120 (99-130) mL/min/1.73 m²] compared to those ≥ 65 years [81 (62-105); p = 0.009]. Patients with preoperative eGFR ≥90 showed significant eGFR decline postoperatively (p <0.0001), while those with eGFR <90 exhibited no significant changes (p = 0.82), except for 3 cases (≥65 years with diabetes and hypertension) in which eGFR fell below 60. Patients aged <65 years showed significant eGFR reductions postoperatively (p <0.001), whereas patients aged ≥ 65 years did not (p = 0.212). ΔeGFR was positively correlated with preoperative basal GH levels (r = 0.421, p = 0.012), ΔGH (r = 0.453, p < 0.001), preoperative IGF-I SDS (r = 0.44, p = 0.008), and ΔIGF-I SDS (r = 0.44, p = 0.009). No significant changes in body composition were observed between the preoperative period and 3 months post-surgery. Discussion: This study revealed significant postoperative eGFR reductions in patients with preoperative eGFR ≥90, with greater reductions in GH and IGF-I levels correlating with more significant decreases in eGFR. Patients with preoperative eGFR <90 or aged ≥65 years showed no significant changes, though renal dysfunction had emerged in several older patients with comorbid diabetes and hypertension. In conclusion, postoperative eGFR declines were commonly observed patients with elevated baseline eGFR (≥ 90) and aged <65 years, likely due to postoperative reduction of GH and IGF-I. Presentation: Saturday, July 12, 2025