Division of Endocrinology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Pediatr Nephrol. 2022 Sep;37(9):2141-2150. doi: 10.1007/s00467-022-05445-0. Epub 2022 Jan 26.
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.
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.
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.
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.
基于血清肌酐的估算肾小球滤过率 (eGFR) 方程包括性别/性别相关的术语。对于跨性别和性别多样化 (TGD) 的年轻人，性别肯定激素 (GAH) 治疗可能会影响血清肌酐，进而影响 eGFR。
在开始 GAH 治疗之前，这项前瞻性、纵向、观察性研究招募了 TGD 年轻人。从病历中提取了作为常规临床护理一部分收集的数据。
对于出生时被指定为男性的参与者 (DMAB，N=92)，在接受雌二醇治疗的 6 个月内血清肌酐降低 (平均±SD 0.83±0.12mg/dL 至 0.76±0.12mg/dL，p<0.001)；对于出生时被指定为女性的参与者 (DFAB，n=194)，在接受睾酮治疗的 6 个月内血清肌酐升高 (0.68±0.10mg/dL 至 0.79±0.11mg/dL，p<0.001)。接受睾酮治疗的 DFAB 参与者的血清肌酐与基线时的 DMAB 参与者相似，而即使在接受雌二醇治疗后，DMAB 参与者的血清肌酐仍高于基线时的 DFAB 参与者。与来自全国健康和营养检查调查的参考组相比，按性别认同而不是按指定性别比较 12 个月 GAH 治疗后的血清肌酐时，更相似。
GAH 治疗在治疗后 6 个月内导致血清肌酐发生变化。临床医生在通过 eGFR 估计肾功能时应考虑患者的激素暴露情况，如果基于血清肌酐的 eGFR 令人担忧，则应使用其他方法来估计 GFR。
