In recent years we have not only learned about new therapy options to slow down cyst growth in ADPKD. PROPKD, a progression score which combines clinical with genetic data, has been validated, which is a tool for the nephrologist in making individual clinical decisions in favour or against (potentially harmful) long-term medications. Patient cohorts have been characterized in whom kidney size remains stable at a certain plateau for years. This article reviews the literature on these new options and discusses possible adjustments of the PROPKD score and treatment options specifically for East Asian patients. Also, a practical concept for the clinic is proposed regarding the best management of CKD patients with ADPKD, making use of the progression score and pharmacogenetic information.