Risk for IAs in Patients with ADPKD

Patients with autosomal dominant polycystic kidney disease (ADPKD) face increased risk for developing intracranial aneurysms (IAs). Siriane LeFèvre, MD, and colleagues conducted an analysis to examine the frequency of diagnosis of IAs to describe IAs associated with ADPKD and to analyze the risk factors associated with the occurrence of IAs in patients with ADPKD. Results were reported in Nephrology Dialysis Transplantation [doi.org/10.1093/ndt/gfac027].

The analysis utilized data from the cross-sectional, population-based Genkyst cohort performed in 26 nephrology centers in western France. All participants underwent genetic testing for PKD1/PKD2 and other cystogenes.

At baseline, of the 2449 participants in the Genkyst study, 4.6% (n=114) had a previous diagnosis of ruptured or unruptured IA, and approximately 47% of those had a positive familial history for IAs. Most aneurysms were small and saccular and were located in the anterior circulation; 26.3% of the patients had multiple IAs.

At ages 50, 60, and 70 years, the cumulative probabilities of a previous diagnosis of IAs were 3.9%, 6.2%, and 8.1%, respectively. In participants <50 years of age, the risk was similar in men and women; however, after age 50, the risk increased more markedly in women, reaching 10.8% versus 5.4% at age 70 years. In PKD1 versus PKD2, the diagnosis rate of IAs was more than 2-fold higher with no influence of PKD1 mutation type or location.

Following adjustment for various factors, there were associations between female sex, hypertension <35 years, smoking status, and PKD1 genotype and increased risk for diagnosis of IAs.

In conclusion, the authors said, “This study presents epidemiological data reflecting real-life clinical practice. The increased risk for IAs in postmenopausal women suggests a possible protective role of estrogen.”