Kidney Week

Abstract: TH-PO473

Sex and Aging Influence the Association between Kidney Prognosis and Anemia in Patients with ADPKD: Attribute-Based Medicine (ABM) Insights

Session Information

• Cystic Kidney Diseases: Clinical Assessment and Therapeutic Directions
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Genetic Diseases of the Kidneys

• 1201 Genetic Diseases of the Kidneys: Cystic

Authors

• Tsuchiya, Ken, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Ken Tsuchiya, MD, PhD

• Kataoka, Hiroshi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Hiroshi Kataoka

• Manabe, Shun, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Shun Manabe, MD, PhD

• Ushio, Yusuke, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Yusuke Ushio, MD, PhD

• Seki, Momoko, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Momoko Seki, DrMed

• Nitta, Kosaku, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Kosaku Nitta, MD, PhD

• Mochizuki, Toshio, PKD Nephrology Clinic, Tokyo, Chu-o-ku, Japan

Toshio Mochizuki, MD, PhD

• Hoshino, Junichi, Tokyo Joshi Ika Daigaku, Shinjuku-ku, Tokyo, Japan

Junichi Hoshino, MD, PhD, MPH

Background

Although anemia is traditionally considered a marker of poor renal prognosis in CKD, the significance and the prognostic role of anemia in ADPKD remains clearly unexplored. Recently, the significance of ABM has been underscored, and the effects of anemia on CKD progression may differ between young male and elderly female patients with ADPKD. We aimed to examine the effects of sex and aging to CKD progression of ADPKD using various levels of anemia.

Methods

We enrolled 553 ADPKD patients. Renal outcome, defined as a 30% reduction in eGFR or initiation of renal replacement therapy, was assessed using Cox regression analysis. Five thresholds of anemia were considered: 1) Hb <12 g/dL in men and Hb<11 g/dL in women; 2) Hb<13 g/dL in men and Hb<12 g/dL in women; 3) Hb<11 g/dL; 4) Hb<12 g/dL; 5) Hb<13g/dL. For subgroup analyses, cross-classification (4 groups) of sex × 50 years was also used for analyses per attribute.

Results

The cohort’s median age was 43 years old, with median eGFR of 55.9 mL/min/1.73 m², and a median total kidney volume of 1335.4 ml. Over a median follow-up period was 9.1 years, renal outcomes were observed in 236 patients. Multivariable Cox analyses revealed that anemia (2: Hb<13.0 g/dL in men, Hb<12.0 g/dL in women; HR=1.81, P=0.0004) had the strongest association with kidney disease progression in the entire cohort. Subgroup analyses showed significant associations between kidney disease progression and anemia (5: Hb<13.0 g/dL; HR=3.46 in men <50 years old, HR=3.11 in men ≥50 years old), anemia (4: Hb<12.0 g/dL; HR=2.00 in men <50 years old), and anemia (3: Hb<11.0 g/dL; HR= 2.18 in women ≥50 years old).

Conclusion

In ADPKD patients, a higher threshold for anemia (Hb<13.0 g/dL in men, Hb<12.0 g/dL in women) was associated with kidney prognosis. Furthermore, cross-classification analysis revealed differential associations between higher thresholds of anemia and renal prognosis in male and younger patients, while a lower threshold (Hb<11.0 g/dL) was associated with renal prognosis in elderly women (women ≥50 years old). These findings underscore the utility of ABM care, employing cross-classification, in managing anemia in ADPKD patients.

Funding

• Government Support – Non-U.S.