Autosomal dominant polycystic kidney disease (ADPKD), the most common monogenic kidney disorder, exhibits a marked variability in kidney disease progression. Risk factors and biomarkers may allow patient stratification based on risk, evaluation of disease progression, and/or implementation and monitoring of therapies expected to delay the onset of end-stage kidney disease. The study by Nowak et al1 in this issue of AJKD expands the biomarker/risk factor scenario in ADPKD, by identifying independent association between visceral abdominal adiposity (VAA) and total kidney volume (TKV) growth and suggesting VAA as a potential novel biomarker for ADPKD progression.