Risk factors for postoperative renal function decline after laparoscopic adrenalectomy in patients with primary...

Renal function decline has been observed in primary aldosteronism (PA) after adrenalectomy. This study aims to evaluate renal function changes after six months post-adrenalectomy and identify predictors of significant estimated glomerular filtration rate (eGFR) decline to aid in risk stratification.

This retrospective cohort study analyzed the medical records of patients with PA who underwent laparoscopic adrenalectomy at King Chulalongkorn Memorial Hospital, Thailand (between 2003 and 2025). Demographic and clinical data, including preoperative and postoperative eGFR, were collected. Renal function decline (eGFR decline) was defined as a ≥25% reduction of eGFR at 6 months postoperative compared with preoperative. Multivariate logistic regression was performed to identify independent predictors of renal function decline.

A total of 347 patients were included. After surgery, 251 patients (72.3 %) experienced a renal function decline with a significant mean decrease eGFR from 87.7 to 79 mL/min/1.73 m² (P=0.001). Independent risk factors for renal function decline included the higher number of antihypertensive medications (P=0.03), presence of coronary heart disease (CHD) (P=0.02), lower preoperative potassium levels (P=0.03), and higher preoperative eGFR (P=0.01).

A significant proportion of patients experience renal function decline following adrenalectomy for PA. Patients with multiple antihypertensive medications, CHD, and lower preoperative potassium and higher eGFR levels are at higher risk. These findings underscore the need for preoperative risk stratification and close postoperative monitoring to optimize long-term renal outcomes.