Overweight/Obesity and Pulse Pressure: Kidney Prognosis in Young and Elderly Patients with ADPKD Regarding Attribute-Based Medicine (ABM) Insights

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. Funding: Government Support – Non-U.S.