ニッタ　コウサク   NITTA Kousaku   新田　孝作    所属   医学部 医学科（東京女子医科大学病院）    職種   客員教授
言語種別	英語
発表タイトル	Anemia and Kidney Prognosis in ADPKD: Insights from Attribute-Based Cross-Classification by Sex and Age
会議名	Kidney Week 2025
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	ポスター掲示
講演区分	一般
発表者・共同発表者	◎Nitta Kosaku, Kataoka Hiroshi, Mochizuki Toshio, Tsuchiya Ken, Hoshino Junichi
発表年月日	2025/11/07
国名	アメリカ合衆国
開催地 （都市, 国名）	Houston, USA
開催期間	2025/11/05～2025/11/09
概要	Background Although anemia is less prevalent in autosomal dominant polycystic kidney disease (ADPKD) due to relatively preserved erythropoietin production, the prognostic significance of anemia in this population remains unclear. Given the sex differences in hemoglobin (Hb) levels and the increasing emphasis on attribute-based medicine (ABM), we hypothesized that the impact of anemia on kidney outcomes in ADPKD may vary by sex and age. Methods We analyzed 553 Japanese patients with ADPKD from a multicenter cohort. The primary outcome was a 30% decline in estimated glomerular filtration rate (eGFR) or initiation of renal replacement therapy. Cox regression models were used to evaluate the prognostic significance of Hb levels and anemia, with subgroup analyses cross-classified by sex and age (<50 or ≥50 years). Anemia was defined using Hb thresholds of <11.0, <12.0, and <13.0 g/dL. Results The cohort had a median age of 43 years and median eGFR of 55.9 mL/min/1.73 m2. Anemia prevalence was highest in older women and lowest in younger men. Over a mean follow-up of 6.9 years, 266 patients reached the primary endpoint. In the overall cohort, lower Hb levels were independently associated with worse renal outcomes (HR per 1 g/dL increase: 0.83; 95% CI: 0.75–0.91; P < 0.001). Cross-classified analyses revealed distinct risk patterns. Anemia (Hb <13.0 g/dL) significantly increased the risk in younger men (HR: 2.92; P = 0.028) and older men (HR: 3.84; P = 0.017). In women, anemia defined as Hb <12.0 g/dL was associated with adverse outcomes in both age groups (HR: 1.98; P = 0.035 in <50 years; HR: 2.08; P = 0.045 in ≥50 years). Additional factors such as eGFR, total kidney volume (TKV), urinary protein excretion, and hypertension also contributed to prognosis depending on sex and age. Conclusion Anemia is an independent risk factor for kidney disease progression in patients with ADPKD, with its prognostic impact differing by sex and age. These findings highlight the importance of attribute-based approaches in anemia assessment and management in ADPKD, suggesting that individualized Hb targets may be warranted in future therapeutic strategies.