Browsing by Author "Ahmed, Sofia Bano"

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    The effect of CPAP therapy on kidney function in CKD patients with OSA
    (2020-01-28) Rimke, Alexander; Hanly, Patrick Joseph; Ahmed, Sofia Bano; Pendharkar, Sachin R.; Chowdhury, Tanvir Turin
    Introduction: Chronic kidney disease (CKD) is a prevalent disorder with significant consequences on patients’ health outcomes and substantial costs to the healthcare system. Obstructive sleep apnea (OSA) is present in ~40% of CKD patients and may contribute to worsening kidney function. A pilot study to investigate the effects of continuous positive airway pressure (CPAP) on kidney function in patients with CKD and OSA was performed to determine potential effects on health outcomes and feasibility of a larger study. Methods: The study was a randomized, controlled, non-blinded, parallel clinical trial in which CKD patients were screened for OSA. Although a convenience sample of 60 patients with stage 3 and 4 CKD and OSA was planned, recruitment was stopped after 57 patients due to budgetary constraints. Patients were randomized to receive usual medical treatment for CKD or usual treatment and CPAP for 12 months. Home sleep apnea tests were performed at baseline and 12 months and CPAP adherence was monitored throughout the study. Recruiting trends were recorded from July 2015 to July 2018. Estimated glomerular filtration rate (eGFR) and albumin:creatinine ratio (ACR) were recorded every three months for 12 months. Results: 57 patients were randomized from the 1665 patients eligible for the study; however, follow-up data at 12 months was obtained in 51 patients. Recruitment failure occurred primarily due to insufficient recruiters (461 patients) and refused consent (645 patients). While there were no significant differences in eGFR and ACR over 12 months between the two groups, a trend for improvement in eGFR and ACR in patients considered at low risk of progression to end-stage kidney disease occurred. Conclusions: Recruitment of CKD patients with OSA for a clinical trial was challenging, but several strategies may improve enrolment in future studies. Although primary analysis did not show treatment of OSA in patients with stage 3 and 4 CKD improved eGFR and ACR, there was a trend for CPAP to improve these outcomes in patients with a low risk of CKD progression. This pilot randomized controlled trial provides preliminary data to determine if a larger clinical trial is merited and its future design.
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    The Cardiovascular Implications of Gender-Affirming Estrogen Therapy Use in Transgender Women
    (2024-04-24) Rytz, Chantal Louise; Ahmed, Sofia Bano; Saad, Nathalie; Dumanski, Sandra Marie; Ronksely, Paul Everett; Raj, Satish R.; Somayaji, Ranjani
    Cardiovascular disease is a leading cause of death globally, with transgender and gender diverse (TGD) individuals, and particularly transgender women (sex assigned male at birth who identify as women) facing significant rates of cardiovascular-related morbidity and mortality. While uncertainties exist regarding the potential contribution of gender-affirming estrogen therapy in the increased cardiovascular risk noted in this population, there remains a critical evidence gap in understanding how factors such as serum estradiol levels, sex assigned at birth, and gender identity impact cardiovascular risk. Therefore it was the objective of this thesis to determine the cardiovascular implications of gender-affirming hormone therapy in transgender women, which was explored from various angles through conducting three independent studies. Our first study provides an understanding of the association between serum estradiol and cardiovascular-related mortality, adverse cardiovascular events and cardiovascular related risk factors using a systematic review and meta-analysis approach. We determined that the rate of serum estradiol change across the use of gender-affirming estrogen therapy may influence cardiovascular risk factors, which may have implications for clinical cardiovascular outcomes. Using a cross-sectional approach, our second study evaluated the impact of gender identity and sex assigned at birth on measures of vascular hemodynamics and arterial stiffness in transgender women as compared to cisgender women and men. Our findings underscore the importance of considering gender identity in addition sex assigned at birth when evaluating measures of cardiovascular health and risk. Our final study addressed the major methodological limitation with retrospective studies within the TGD population by generating and validating numerous case-definitions to identify both transgender women and men in routinely-collected healthcare data in Alberta, Canada. By linking numerous administrative data sources and testing against a reference standard of self-identified gender identity, a combination of using sex assigned in provincial registry and exogenous hormone dispensations or TGD-related billing codes were the most sensitive at identifying TGD individuals, and were employed to approximate both prevalence and incidence per 100,000 person-years, providing a first-ever assessment of the TGD population within Alberta. Despite recent advances and calls for the incorporation of both sex and gender into health research and clinical care, gaps in the understanding of cardiovascular health in transgender women remain. Our findings highlight numerous factors that may be implicated in cardiovascular health and risk in the transgender women population. This thesis may inform areas for further interventions aimed at improving cardiovascular health, mitigating cardiovascular disease risk, and exploring clinical cardiovascular outcomes in transgender women.