TSUCHIYA Ken    Department   School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine    Position   Professor (Fixed Term)
Language	English
Title	Overweight/Obesity and Pulse Pressure: Kidney Prognosis in Young and Elderly Patients with ADPKD Regarding Attribute-Based Medicine (ABM) Insights
Conference	Kidney Week 2024
Promoters	American Society of Nephrology
Conference Type	International society and overseas society
Presentation Type	Poster notice
Lecture Type	General
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 How aging impacts renal prognosis in autosomal dominant polycystic kidney disease (ADPKD) has yet to be fully undertaken. We sought to explore these distinctions in kidney disease progression among young and elderly ADPKD patients, focusing on the influence of overweight/obesity and pulse pressure, related markers of arteriosclerosis. 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 30% reduction in estimated glomerular filtration rate or initiation of renal replacement therapy, was assessed using Cox regression analysis. Results The study followed 236 patients over a median period of 9.1 years to assess renal outcomes. Multivariable Cox analyses identified several significant risk factors for kidney disease progression: female sex (HR=1.82), age (HR=0.76 per 10-year increase), eGFR (HR=0.58 per 10 mL/min/1.73 m2 increase), urinary protein excretion (HR=1.72), and total kidney volume (HR=1.03 per 100 mL increase). Notably, interactions were observed between age (≥50 years) and urinary protein excretion (P=0.0050), higher pulse pressure (≥50 mmHg) (P=0.0386), and overweight (BMI ≥25 kg/m2)(P=0.0414). Subgroup analysis revealed that total kidney volume (HR=1.03 per 100 mL increase) and overweight/obesity (HR=2.01) were risk factors in patients under 50, while urinary protein (HR=2.55) and pulse pressure ≥50 mmHg (HR=1.74) were significant in patients over 50. Conclusion Poor renal prognosis was associated with increased total kidney volume and obesity in younger patients, but increased protein in the urine and increased pulse pressure in older patients. 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 age attributes.