Objectives: Autosomal dominant polycystic kidney disease (ADPKD) patients reach end-stage kidney disease (ESKD) in their 5th decade on average. The definition of rapid progression (RP) is evolving without an international consensus yet. In USA, the Mayo Imaging Classification (MIC) has been advocated by nephrologists without additional markers of rapid progression; whereas the European experts have advocated more permissive approach to MIC1C by adding other markers to confirm the RP. This study assessed the clinical utility of European algorithm in prediction of RP among the patients enrolled in RAPID-ADPKD study which was the multinational retrospective observational cohort study of ADPKD patients in the Asia-Pacific area. Methods: Five hospitals from five regions (Australia, China, South Korea, Taipei and Turkey) participated in this study. The ERA-EDTA Working Groups on Inherited Kidney Disorders and European Renal Best Practice algorithm was used to assess RP. Results: Seven hundred and sixty-eight patients were enrolled. Historical eGFR decline had fulfilled the criteria for ‘RP’ (eGFR decline ≥5ml/min/1.73 m2 in one year or eGFR decline ≥2.5ml/min/1.73 m2 per year over a period of five years or more) in 210 patients. Five patients met the criteria for historical increase of height adjusted total kidney volume (more than 5% per year by repeated measurements). The 206 patients with MIC 1C, 1D, or 1E and 4 patients with kidney length (>16.5 ㎝) were considered to have ‘likely RP’. One patient was a likely RP’ by meeting PRO-PKD score>6. Three hundred and forty-two patients were slow progressor Conclusions: The ERA-EDTA Working Groups on Inherited Kidney Disorders and European Renal Best Practice algorithm will provide a valuable role in identifying RP in routine clinical practice, especially in the situations where total kidney volume cannot be measured properly.