ツチヤ　ケン   Tsuchiya Ken   土谷　健    所属   医学部 医学科（東京女子医科大学病院）    職種   特任教授
言語種別	英語
発表タイトル	Sex Differences in Kidney Prognosis in Patients with ADPKD: Attribute-Based Medicine (ABM) Insights
会議名	Kidney Week 2024
主催者	American Society of Nephrology
学会区分	国際学会及び海外の学会
発表形式	口頭
発表者・共同発表者	◎Kataoka Hiroshi, Mochizuki Toshio, Manabe Shun, Ushio Yusuke, Seki Momoko, Tsuchiya Ken, Nitta Kosaku, Hoshino Junichi,
発表年月日	2024/10/25
国名	アメリカ合衆国
開催地 （都市, 国名）	San Diego, USA
開催期間	2024/10/24～2024/10/27
概要	Background Recently, the importance of attribute-based medicine has been emphasized. We aimed to examine the influence of sex differences to kidney disease progression of autosomal dominant polycystic kidney disease (ADPKD). Methods We enrolled 553 ADPKD patients who were not undergoing renal replacement therapy, with a median age of 43 years, an estimated glomerular filtration rate of 55.9 mL/min/1.73 m2, and a total kidney volume of 1335.4 mL. The renal outcome, defined as a 50% reduction in estimated glomerular filtration rate or initiation of renal replacement therapy, was assessed using Cox regression analysis. Factors influencing kidney prognosis in ADPKD patients were compared based on sex categories (men or women). Results Over a median 9.1-year follow-up, renal outcomes were assessed in 189 patients. Multivariate Cox analysis identified several significant risk factors for kidney disease progression: female gender (HR=1.56), age (HR for 10-year increase=0.63), eGFR (HR for 10 mL/min/1.73 m2 increase=0.48), urinary protein excretion (grades 0–3) (HR=2.05), total kidney volume (HR for 100 ml increase=1.02), and hypertension (HR=1.48). Significantly, interactions were observed between gender and urinary protein excretion (grades 0–3) (P=0.0158), hypertension (P=0.0065), and higher pulse pressure (≥50mmHg) (P=0.0117) concerning kidney disease progression. Subgroup analysis by gender clarified age and eGFR's association with kidney prognosis across both sub-cohorts. Conversely, hypertension (HR=2.47), pulse pressure ≥50 mmHg (HR=2.28), and urinary protein (grades 0–3) (HR=3.11) emerged as factors associated with kidney prognosis in females, whereas hypertension (HR=0.82), pulse pressure ≥50 mmHg (HR=0.90), and urinary protein (grades 0–3) (HR=1.62) were less associated with renal outcomes in males. Conclusion Female sex was a factor for poor renal prognosis in patients with ADPKD. Hypertension, high pulse pressure, and increased proteinuria were significantly worse factors for renal prognosis in women than in men. In recent years, treatments and research that are tailored to patient attributes have been proposed, but in the case of ADPKD patients, it is necessary to change treatment policies depending on sex attributes.