Chronic Kidney Disease in the Transgender, Nonbinary, or Gender Diverse Person

David Collister; Yonah Krakowsky; Emery Potter; Adam C Millar

doi:10.1016/j.semnephrol.2022.04.004

Chronic Kidney Disease in the Transgender, Nonbinary, or Gender Diverse Person

Semin Nephrol. 2022 Mar;42(2):129-141. doi: 10.1016/j.semnephrol.2022.04.004.

Authors

David Collister¹, Yonah Krakowsky², Emery Potter³, Adam C Millar⁴

Affiliations

¹ Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; Population Health Research Institute, Hamilton, Ontario, Canada. Electronic address: dtcollister@gmail.com.
² Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada.
³ Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
⁴ Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Endocrinology and Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

PMID: 35718361
DOI: 10.1016/j.semnephrol.2022.04.004

Abstract

Nephrologists are increasingly providing care to transgender, nonbinary, and gender diverse (TNBGD) individuals with chronic kidney disease. This narrative review discusses the care of TNBGD individuals from a nephrology perspective. TNBGD individuals are under-represented in the nephrology literature. TNBGD individuals are at an increased risk of adverse outcomes compared with the cisgender population including mental health, cardiovascular disease, malignancy, sexually transmitted infections, and mortality. Gender-affirming hormone therapy (GAHT) with estradiol in transfeminine individuals potentially increases the risk of venous thromboembolism and cardiovascular disease. GAHT with testosterone in transmasculine individuals potentially increases the risk of erythrocytosis and requires careful monitoring. GAHT modifies body composition and lean muscle mass, which in turn influence creatinine generation and excretion, which may impact the performance of estimated glomerular filtration rate (GFR) equations and the estimation of 24-hour urine values from spot urine albumin/protein to creatinine ratios. There are limited studies regarding TNBGD individuals with chronic kidney disease. Additional research is needed to evaluate the effects of GAHT on GFR and biomarkers of kidney function and the performance of the estimated GFR equation in TNBGD populations.

Keywords: Transgender; chronic kidney disease; gender diverse; nonbinary.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases*
Creatinine
Humans
Renal Insufficiency, Chronic* / complications
Testosterone / therapeutic use
Transgender Persons*

Substances

Testosterone
Creatinine