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

  • David Collister
    Address reprint requests to David Collister, MD, PhD, Division of Nephrology, University of Alberta, 11-113H Clinical Sciences Building, Edmonton, Alberta, Canada.
    Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada

    Population Health Research Institute, Hamilton, Ontario, Canada
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  • Yonah Krakowsky
    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
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  • Emery Potter
    Department of Surgery, Women's College Hospital, Toronto, Ontario, Canada

    Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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  • Adam C. Millar
    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
    Search for articles by this author


      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.


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