Kidney function in acromegaly: evidence from a long-term observational study

Purpose: Growth hormone (GH) and insulin-like growth factor 1 (IGF-1) are critical regulators of renal development and function. Acromegaly, characterized by chronic GH hypersecretion, leads to renal hypertrophy and glomerular hyperfiltration. While immediate treatment of acromegaly mitigates hyperfiltration, the long-term risk of renal damage in treated patients remains unclear. Our study aimed to assess renal function over time in patients with acromegaly who were followed long-term at our institution. Methods: This study analyzed 80 patients with acromegaly from a single center. Creatinine values were recorded to assess kidney function before and after treatment. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI 2021 formula. eGFR variations were evaluated over the first 12 months after treatment (acute slope) and during long-term follow-up with a mean duration of 11.28 years (chronic slope). Descriptive statistics and multivariable regression analyses were performed. Results: Among the 80 patients (43.7 years, 46 male), 51 underwent surgery (11 of whom also received subsequent radiotherapy), while 29 received exclusively medical therapy. Comorbidities included diabetes (31.25%) and hypertension (65%). eGFR decreased acutely after treatment in all groups, with a more pronounced decline in surgically treated patients (mean − 15.15 mL/min/1.73 m²; p = 0.042). The mean chronic eGFR loss was − 1.28 mL/year, with age (OR 1.09 per year) and diabetes (OR 5.66) significantly associated with a greater decline in eGFR (p < 0.01). Conclusions: Renal hyperfiltration in acromegaly tends to normalize following treatment, with a more rapid response observed in patients who undergo surgery. Chronic kidney disease is highly prevalent in acromegaly and is closely linked to diabetes, which further contributes to the increased cardiovascular risk seen in these individuals.