Random forest analysis identified age (35.8%) and TAPSE/sPAP (22.0%) as dominant predictors.<h4>Conclusions</h4>TAPSE/sPAP ratio is an independent marker of CKD severity enabling non-invasive detection of RV-PA uncoupling, with excellent discriminatory performance in younger but limited utility in older patients, suggesting that age-specific interpretation and integration with renal biomarkers are recommended. This evidence concerns the gene PDZK1IP1 and chronic kidney disease.