成人性别肯定激素治疗与肾功能变化：一项基于人群的回顾性研究。
Gender-affirming Hormone Therapy and Changes in Kidney Function in Adults: A Retrospective Population-based Study.
作者信息
Leon Silvia J, Ferguson Thomas W, Whitlock Reid, Bohm Clara, Komenda Paul, Rigatto Claudio, Tangri Navdeep, Saad Nathalie, Jablonski Ted, Moncrieff Kathleen, Ahmed Sofia B, Fung Raymond, Ahmad Tehmina, Wald Ron, Sidhu Bikrampal, White Christine, Bond Rachel, Bondaz Louis, Nadeau-Fredette Annie-Claire, Druce Irena, Hundemer Gregory L, Williams Laci, Tennankore Karthik, Dahl Marshall, Levin Adeera, Rogers Anna, Burgess Adam, Christie Emily, Collister David
机构信息
Chronic Disease Innovation Centre, Seven Oaks General Hospital, Winnipeg, Manitoba, Canada.
Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba. Winnipeg, Manitoba, Canada.
出版信息
Kidney Med. 2025 Jun 17;7(8):101051. doi: 10.1016/j.xkme.2025.101051. eCollection 2025 Aug.
RATIONALE & OBJECTIVE: Gender-affirming hormone therapy (GAHT) modifies lean body mass and body fat but its impact on kidney function is uncertain. We sought to evaluate the association of GAHT with kidney function and clinical outcomes.
STUDY DESIGN
A retrospective observational cohort study using linked health administrative databases.
SETTING & PARTICIPANTS: Transgender and gender diverse (TGD) adults in Manitoba, Canada from January 1, 2007, to March 31, 2018.
EXPOSURE
GAHT or no GAHT prescriptions.
OUTCOMES
The primary outcome was the change in serum creatinine levels. Secondary outcomes included the change in urine albumin-to-creatinine ratio, incident acute kidney injury, chronic kidney disease, and hypertension.
ANALYTICAL APPROACH
Outcomes were assessed for up to 2 years. Participants were censored at 3 months post-GAHT prescription if it was not refilled. Outcomes between TGD adults treated with and without GAHT (stratified by sex assigned at birth) were compared using multivariable linear regression and Cox proportional hazards models.
RESULTS
We identified 396 TGD adults assigned female at birth (AFAB) (277 receiving GAHT) and 322 TGD adults assigned male at birth (AMAB) (240 receiving GAHT) with longitudinal kidney function measurements. In AFAB persons treated with GAHT compared with no GAHT, serum creatinine levels increased from baseline at 18 months (+7.0 μmol/L, 95% CI, 0.5-14) and 21 months (+10.7 μmol/L, 95% CI, 3-18) but not at any other time point including 24 months. There were no differences in changes in creatinine in AMAB persons treated with GAHT compared with no GAHT. AFAB and AMAB persons initiating GAHT had no significant increased risks of incident chronic kidney disease or hypertension.
LIMITATIONS
Limited sample size, missing data, and residual confounding.
CONCLUSIONS
GAHT is associated with an increase in serum creatinine levels in AFAB persons. Additional research is needed to further evaluate the effect of GAHT on kidney function.
原理与目的
性别确认激素疗法（GAHT）会改变瘦体重和体脂，但它对肾功能的影响尚不确定。我们试图评估GAHT与肾功能及临床结局之间的关联。
研究设计
一项使用关联健康管理数据库的回顾性观察队列研究。
设置与参与者
2007年1月1日至2018年3月31日期间，加拿大曼尼托巴省的跨性别和性别多样化（TGD）成年人。
暴露因素
GAHT处方或无GAHT处方。
结局指标
主要结局指标是血清肌酐水平的变化。次要结局指标包括尿白蛋白与肌酐比值的变化、急性肾损伤、慢性肾脏病和高血压的发生率。
分析方法
对结局指标进行长达2年的评估。如果GAHT处方未重新开具，则在GAHT处方后3个月对参与者进行截尾。使用多变量线性回归和Cox比例风险模型比较接受和未接受GAHT治疗的TGD成年人（按出生时指定的性别分层）之间的结局。
结果
我们确定了396名出生时被指定为女性（AFAB）的TGD成年人（277名接受GAHT）和322名出生时被指定为男性（AMAB）的TGD成年人（240名接受GAHT），他们有纵向肾功能测量数据。与未接受GAHT治疗的AFAB人群相比，接受GAHT治疗的AFAB人群血清肌酐水平在18个月时从基线升高（+7.0μmol/L，95%CI，0.5-14），在21个月时升高（+10.7μmol/L，95%CI，[3,18]），但在包括24个月在内的任何其他时间点均未升高。与未接受GAHT治疗的AMAB人群相比，接受GAHT治疗的AMAB人群肌酐变化无差异。开始接受GAHT治疗的AFAB和AMAB人群发生慢性肾脏病或高血压的风险没有显著增加。
局限性
样本量有限、数据缺失和残余混杂因素。
结论
GAHT与AFAB人群血清肌酐水平升高有关。需要进一步研究以进一步评估GAHT对肾功能的影响。
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