TSUCHIYA Ken    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor (Fixed Term)
Language	English
Title	Sex Differences in Kidney Prognosis in Patients with ADPKD: Attribute-Based Medicine (ABM) Insights
Conference	Kidney Week 2024
Promoters	American Society of Nephrology
Conference Type	International society and overseas society
Presentation Type	Speech
Publisher and common publisher	◎Kataoka Hiroshi, Mochizuki Toshio, Manabe Shun, Ushio Yusuke, Seki Momoko, Tsuchiya Ken, Nitta Kosaku, Hoshino Junichi,
Date	2024/10/25
Country	United States
Venue (city and name of the country)	San Diego, USA
Holding period	2024/10/24～2024/10/27
Summary	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.