Cystatin C–Based eGFR Changes during Gender-Affirming Hormone Therapy in Transgender Individuals

医学 肌酐 肾功能 变性人 胱抑素C 内科学 睾酮(贴片) 内分泌学 置信区间 性激素结合球蛋白 激素 泌尿科 雄激素 心理学 精神分析
作者
Sarah Annemieke van Eeghen,Chantal M. Wiepjes,Guy T’Sjoen,Natalie Nokoff,Martin den Heijer,Petter Bjornstad,Daniël H. van Raalte
出处
期刊:Clinical Journal of The American Society of Nephrology [Lippincott Williams & Wilkins]
卷期号:18 (12): 1545-1554 被引量:6
标识
DOI:10.2215/cjn.0000000000000289
摘要

Background Men with CKD tend to experience a faster eGFR decline than women, potentially because of sex hormones. Limited research exists regarding the effect of gender-affirming hormone therapy (GAHT) on kidney function. Furthermore, monitoring kidney function during GAHT is challenging because serum creatinine is confounded by body composition. To investigate the relationship between sex hormones and kidney function, we studied the changes of serum creatinine and serum cystatin C, a filtration marker less affected by sex, during 1 year of GAHT. Methods As part of the European Network for the Investigation of Gender Incongruence study, we measured serum creatinine and serum cystatin C in 260 transgender women and 285 transgender men before and 12 months after initiating GAHT. Transgender women received estradiol plus cyproterone acetate, while transgender men received testosterone. Cystatin C–based eGFR was calculated using the full-age-spectrum equation. Results In transgender women, cystatin C decreased by 0.069 mg/L (95% confidence interval [CI], 0.049 to 0.089), corresponding with a 7 ml/min per 1.73 m 2 increase in eGFR. In transgender men, cystatin C increased by 0.052 mg/L (95% CI, 0.031 to 0.072), corresponding with a 6 ml/min per 1.73 m 2 decrease in eGFR. Creatinine concentrations decreased (−0.065 mg/dl; 95% CI, −0.076 to −0.054) in transgender women and increased (+0.131 mg/dl; 95% CI, 0.119 to 0.142) in transgender men. Changes in creatinine-based eGFR varied substantially depending on the sex used in the equation. Conclusions In this cohort of transgender individuals, cystatin C–based eGFR increased with estradiol and antiandrogen therapy and decreased with testosterone therapy.
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