Kate Millington1,2, Ellis Barrera3, Ankana Daga4,5, Nina Mann4,5, Johanna Olson-Kennedy6, Robert Garofalo7, Stephen M Rosenthal8, Yee-Ming Chan3,4. 1. Division of Endocrinology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. Kate.Millington@childrens.harvard.edu. 2. Department of Pediatrics, Harvard Medical School, Boston, MA, USA. Kate.Millington@childrens.harvard.edu. 3. Division of Endocrinology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA. 4. Department of Pediatrics, Harvard Medical School, Boston, MA, USA. 5. Division of Nephrology, Boston Children's Hospital, Boston, MA, USA. 6. Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA. 7. Division of Adolescent Medicine, Lurie Children's Hospital, Chicago, IL, USA. 8. Division of Pediatric Endocrinology, Benioff Children's Hospital, University of California at San Francisco, San Francisco, CA, USA.
Abstract
BACKGROUND: Equations for estimated glomerular filtration rate (eGFR) based on serum creatinine include terms for sex/gender. For transgender and gender-diverse (TGD) youth, gender-affirming hormone (GAH) treatment may affect serum creatinine and in turn eGFR. METHODS: TGD youth were recruited for this prospective, longitudinal, observational study prior to starting GAH treatment. Data collected as part of routine clinical care were abstracted from the medical record. RESULTS: For participants designated male at birth (DMAB, N = 92), serum creatinine decreased within 6 months of estradiol treatment (mean ± SD 0.83 ± 0.12 mg/dL to 0.76 ± 0.12 mg/dL, p < 0.001); for participants designated female at birth (DFAB, n = 194), serum creatinine increased within 6 months of testosterone treatment (0.68 ± 0.10 mg/dL to 0.79 ± 0.11 mg/dL, p < 0.001). Participants DFAB treated with testosterone had serum creatinine similar to that of participants DMAB at baseline, whereas even after estradiol treatment, serum creatinine in participants DMAB remained higher than that of participants DFAB at baseline. Compared to reference groups drawn from the National Health and Nutritional Examination Survey, serum creatinine after 12 months of GAH was more similar when compared by gender identity than by designated sex. CONCLUSION: GAH treatment leads to changes in serum creatinine within 6 months of treatment. Clinicians should consider a patient's hormonal exposure when estimating kidney function via eGFR and use other methods to estimate GFR if eGFR based on serum creatinine is concerning.
BACKGROUND: Equations for estimated glomerular filtration rate (eGFR) based on serum creatinine include terms for sex/gender. For transgender and gender-diverse (TGD) youth, gender-affirming hormone (GAH) treatment may affect serum creatinine and in turn eGFR. METHODS: TGD youth were recruited for this prospective, longitudinal, observational study prior to starting GAH treatment. Data collected as part of routine clinical care were abstracted from the medical record. RESULTS: For participants designated male at birth (DMAB, N = 92), serum creatinine decreased within 6 months of estradiol treatment (mean ± SD 0.83 ± 0.12 mg/dL to 0.76 ± 0.12 mg/dL, p < 0.001); for participants designated female at birth (DFAB, n = 194), serum creatinine increased within 6 months of testosterone treatment (0.68 ± 0.10 mg/dL to 0.79 ± 0.11 mg/dL, p < 0.001). Participants DFAB treated with testosterone had serum creatinine similar to that of participants DMAB at baseline, whereas even after estradiol treatment, serum creatinine in participants DMAB remained higher than that of participants DFAB at baseline. Compared to reference groups drawn from the National Health and Nutritional Examination Survey, serum creatinine after 12 months of GAH was more similar when compared by gender identity than by designated sex. CONCLUSION: GAH treatment leads to changes in serum creatinine within 6 months of treatment. Clinicians should consider a patient's hormonal exposure when estimating kidney function via eGFR and use other methods to estimate GFR if eGFR based on serum creatinine is concerning.
Authors: Johanna Olson-Kennedy; Yee-Ming Chan; Robert Garofalo; Norman Spack; Diane Chen; Leslie Clark; Diane Ehrensaft; Marco Hidalgo; Amy Tishelman; Stephen Rosenthal Journal: JMIR Res Protoc Date: 2019-07-09