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While the disease affects both sexes, disease expression and complications differ significantly between men and women. This review explores the biological, hormonal and psychosocial sex differences in ADPKD across multiple clinical domains. Men tend to experience faster kidney growth, earlier onset of hypertension and slightly younger age at kidney replacement therapy. Women, in contrast, are more susceptible to polycystic liver disease (PLD), often exacerbated by oestrogen exposure, especially during pregnancy or hormonal treatments. Although urinary tract infections are more prevalent among women, cyst infections show no major sex-based difference in incidence, although men may respond less favourably to antibiotic therapy. Cardiovascular complications, intracranial aneurysms and reproductive health risks also show sex-related patterns. Fertility and reproductive counselling must be individualized, as reproductive challenges and risks differ markedly between men and women. Pregnancy in women with ADPKD, especially those with reduced renal function or PLD, carries increased risks and requires specialized care. Fertility in men with ADPKD is usually preserved, although<\/jats:p>\n                  <jats:p>sometimes it may be impaired due to seminal vesicle cysts and sperm morphological abnormalities. However, assisted reproductive techniques generally achieve outcomes comparable to those of unaffected individuals. Psychosocial aspects such as pain, emotional burden and quality of life are also influenced by sex and require integrated management strategies. While tolvaptan slows disease progression in both sexes, pharmacodynamic responses may differ slightly. Incorporating sex-specific insights into ADPKD care, including hormonal and reproductive considerations, is critical to advancing personalized medicine. Understanding these differences will optimize management and improve quality of life for individuals living with ADPKD.<\/jats:p>","DOI":"10.1093\/ckj\/sfaf359","type":"journal-article","created":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T13:38:28Z","timestamp":1763645908000},"source":"Crossref","is-referenced-by-count":1,"title":["Unravelling sex-specific differences in autosomal dominant polycystic kidney disease: a multiorgan perspective"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1025-3901","authenticated-orcid":false,"given":"M\u00f3nica","family":"Furlano","sequence":"first","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona Nephrology Department, Fundaci\u00f3 Puigvert, Institut de Recerca Sant Pau (IR-Sant Pau), Departament de Medicina, , Barcelona, RICORS2040 renal ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adria","family":"Tinoco","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona Nephrology Department, Fundaci\u00f3 Puigvert, Institut de Recerca Sant Pau (IR-Sant Pau), Departament de Medicina, , Barcelona, RICORS2040 renal ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3950-3777","authenticated-orcid":false,"given":"Diego","family":"Toso","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona Nephrology Department, Fundaci\u00f3 Puigvert, Institut de Recerca Sant Pau (IR-Sant Pau), Departament de Medicina, , Barcelona, RICORS2040 renal ,","place":["Spain"]},{"name":"Division of Nephrology and Dialysis , Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia ,","place":["Italy"]},{"name":"University of Brescia Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, , Brescia ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Polo","sequence":"additional","affiliation":[{"name":"Programa de Reproducci\u00f3 Assistida, Fundaci\u00f3 Puigvert Obstetrics and Gynecology Department, , Barcelona ,","place":["Spain"]},{"name":"Universitat Aut\u00f2noma de Barcelona Departament de Medicina, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9760-2854","authenticated-orcid":false,"given":"Olga","family":"Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Assisted Reproduction Laboratory, Fundaci\u00f3 Puigvert \u00a0 Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4048-6407","authenticated-orcid":false,"given":"Elisa","family":"Llurba","sequence":"additional","affiliation":[{"name":"Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Developmental Origin Network (RICORS), RD21\/0012\/0003, Instituto de Salud Carlos III , Madrid ,","place":["Spain"]},{"name":"Institut d\u2019Investigaci\u00f3 Biom\u00e8dica Sant Pau-IIB Sant Pau. Hospital de la Santa Creu i Sant Pau Obstetrics and Gynaecology Department, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9988-7163","authenticated-orcid":false,"given":"Berta Cuyas","family":"Esp\u00ed","sequence":"additional","affiliation":[{"name":"Hospital de la Santa Creu i Sant Pau, CIBERehd Gastroenterology and Hepatology Department, ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesc","family":"Maestre","sequence":"additional","affiliation":[{"name":"Fundaci\u00f3 Puigvert Psychology Departament, , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Marco","sequence":"additional","affiliation":[{"name":"Universitat Aut\u00f2noma de Barcelona Nephrology Department, Fundaci\u00f3 Puigvert, Institut de Recerca Sant Pau (IR-Sant Pau), Departament de Medicina, , Barcelona, RICORS2040 renal 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