Browsing by Author "Saad, Nathalie"

Now showing 1 - 3 of 3
  • Thumbnail Image
    ItemOpen Access
    A comparison of prediction equations for the estimation of glomerular filtration rate in transgender individuals
    (2023-06) Turino Miranda, Keila; Ahmed, Sofia B.; Dumanski, Sandra M.; Ahmed, Sofia B.; Dumanski, Sandra M.; Saad, Nathalie
    The transgender population (gender identity differs from sex assigned at birth) is estimated to be comprised of 25 million people worldwide. An accurate assessment of kidney function in this population is imperative to ensure appropriate and timely health care delivery to meet the needs of this growing yet medically underserved population. However, whether the variable “sex assigned at birth” or a binary “gender identity” is most appropriate to use in calculation of kidney function with currently used glomerular filtration rate (GFR) estimation equations is unknown, with important implications for care of the transgender, gender-diverse, and non-binary individuals. Furthermore, the use of gender-affirming hormone therapy for the acquisition of secondary sex characteristics to align these individuals with their affirmed gender is increasingly common with associated changes in serum creatinine, a biomarker commonly used to estimate kidney function. The paucity of current literature evaluating chronic kidney disease (CKD) prevalence and outcomes in transgender, gender-diverse and non-binary individuals on gender-affirming hormone therapy makes it difficult to accurately assess the effects of gender-affirming hormone therapy on kidney function. Creatinine increases with the use of gender-affirming testosterone in transmasculine individuals and decreases in association with use of gender-affirming estrogen therapy in transfeminine individuals. Whether these alternations in serum creatinine reflect changes in kidney function or simply changes in muscle mass is unknown. Therefore, the work described in this thesis aims to compare existing GFR prediction equations with the gold standard, directly measured GFR, in transgender, gender-diverse, and non-binary individuals on a stable regimen of gender-affirming hormone therapy. This project addresses methods for optimal estimation of kidney function in the transgender, gender-diverse, and non-binary population on gender-affirming hormone therapy, which may guide clinical decision-making including nephrology consultation, medication dosing, risk of acute kidney injury with diagnostic imaging with intravenous contrast, referral for kidney transplantation, and timing of dialysis initiation.
  • Thumbnail Image
    ItemOpen Access
    The Association Between Income and Patient-Reported Diabetes Care: Results of a Cross-Sectional Survey
    (2016) Saad, Nathalie; Hemmelgarn, Brenda; McBrien, Kerry; Edwards, Alun; Zhang, Jianguo
    The main objective of this study was to evaluate the association between income and indicators of access to care as well as indicators of guideline-concordant recommended care in patients with diabetes and poor glycemic control. We used data from a cross-sectional telephone survey of outpatients with diabetes and linked this data with administrative and laboratory data. The study population included adult outpatients living in Calgary, Alberta with diabetes. The exposure was the total household income in the prior 12 months, as reported by survey respondents. We conducted a poisson regression analysis to determine the association between income and each of the outcome variables. We found that participants with an annual household income of < $20,000 were less likely to report taking recommended aspirin as well as statin therapy compared to those with an annual household income > $50,000. Further research is required to delineate the underlying reasons for these results.
  • Thumbnail Image
    ItemOpen Access
    The Cardiovascular Implications of Gender-Affirming Estrogen Therapy Use in Transgender Women
    (2024-04-24) Rytz, Chantal Louise; Ahmed, Sofia Bano; Saad, Nathalie; Dumanski, Sandra Marie; Ronksely, Paul Everett; Raj, Satish R.; Somayaji, Ranjani
    Cardiovascular disease is a leading cause of death globally, with transgender and gender diverse (TGD) individuals, and particularly transgender women (sex assigned male at birth who identify as women) facing significant rates of cardiovascular-related morbidity and mortality. While uncertainties exist regarding the potential contribution of gender-affirming estrogen therapy in the increased cardiovascular risk noted in this population, there remains a critical evidence gap in understanding how factors such as serum estradiol levels, sex assigned at birth, and gender identity impact cardiovascular risk. Therefore it was the objective of this thesis to determine the cardiovascular implications of gender-affirming hormone therapy in transgender women, which was explored from various angles through conducting three independent studies. Our first study provides an understanding of the association between serum estradiol and cardiovascular-related mortality, adverse cardiovascular events and cardiovascular related risk factors using a systematic review and meta-analysis approach. We determined that the rate of serum estradiol change across the use of gender-affirming estrogen therapy may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes. Using a cross-sectional approach, our second study evaluated the impact of gender identity and sex assigned at birth on measures of vascular hemodynamics and arterial stiffness in transgender women as compared to cisgender women and men. Our findings underscore the importance of considering gender identity in addition sex assigned at birth when evaluating measures of cardiovascular health and risk. Our final study addressed the major methodological limitation with retrospective studies within the TGD population by generating and validating numerous case-definitions to identify both transgender women and men in routinely-collected healthcare data in Alberta, Canada. By linking numerous administrative data sources and testing against a reference standard of self-identified gender identity, a combination of using sex assigned in provincial registry and exogenous hormone dispensations or TGD-related billing codes were the most sensitive at identifying TGD individuals, and were employed to approximate both prevalence and incidence per 100,000 person-years, providing a first-ever assessment of the TGD population within Alberta. Despite recent advances and calls for the incorporation of both sex and gender into health research and clinical care, gaps in the understanding of cardiovascular health in transgender women remain. Our findings highlight numerous factors that may be implicated in cardiovascular health and risk in the transgender women population. This thesis may inform areas for further interventions aimed at improving cardiovascular health, mitigating cardiovascular disease risk, and exploring clinical cardiovascular outcomes in transgender women.