A comparison of prediction equations for the estimation of glomerular filtration rate in transgender individuals
Date
2023-06
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Abstract
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.
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Keywords
transgender, nephrology, glomerular filtration rate, validation, gender affirming hormone therapy, exogenous hormones
Citation
Turino Miranda, K. (2023). A comparison of prediction equations for the estimation of glomerular filtration rate in transgender individuals (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.