High-Pulse Pressure and Kidney Prognosis in ADPKD: Insights from Attribute-Based Cross-Classification by Sex and Age

Background: The 2024 KDIGO conference emphasized shifting from a one-size-fits-all model to individualized CKD care. High pulse pressure may contribute to disease progression in autosomal dominant polycystic kidney disease (ADPKD), but its prognostic impact remains unclear, especially across sex and age groups. This study investigated its effect on renal outcomes using an Attribute-Based Medicine (ABM) approach with sex–age cross-classification. Methods: We analyzed 553 ADPKD patients not receiving renal replacement therapy (median age: 43 years; eGFR: 55.9 mL/min/1.73 m2; total kidney volume: 1335.4 mL). High pulse pressure was defined as ≥50 mmHg. Patients were cross-classified by sex (men/women) and age (<50/≥50 years). The renal outcome—≥30% eGFR decline or initiation of renal replacement therapy—was assessed via Cox regression. Interaction effects between high pulse pressure and age ≥50 were evaluated in multivariable models. Mean follow-up was 6.9 years; 266 patients experienced renal events. Results: High pulse pressure was not associated with worse renal prognosis in the overall cohort (HR=1.07, P=0.650). A significant interaction was observed between high pulse pressure and age ≥50 in women (interaction P<0.001), but not in men (interaction P=0.623). Cross-classification revealed a strong association between high pulse pressure and poor outcomes in women aged ≥50 years (HR=2.65, P=0.005). No significant associations were observed in other subgroups. These findings suggest that high pulse pressure may exert a particularly detrimental effect on renal prognosis in older women with ADPKD, highlighting the importance of attribute-based risk assessment. Conclusion: High pulse pressure may be a modifiable risk factor for renal progression in ADPKD, particularly in older women. Attribute-based cross-classification analysis offers valuable insight into individualized risk.Attribute-Based Cross-Classification Analysis by Sex and Age