Clinical Factors Associated With Intracranial Aneurysms in Patients With Autosomal Dominant Polycystic Kidney Disease.

Introduction  Autosomal dominant polycystic kidney disease (ADPKD) is associated with an increased prevalence of intracranial aneurysms (IAs), but the clinical factors influencing IA development remain unclear. This study aimed to identify the clinical factors associated with the presence or absence of IAs in patients with ADPKD. Methods  We conducted a retrospective cohort study of 138 Japanese patients with ADPKD who underwent neuroradiological imaging between January 2004 and December 2020. Patients were categorized into IA (n=30) and non-IA (n=108) groups. Clinical characteristics, including age at ADPKD diagnosis, dialysis status, comorbidities, and family history of IA, were compared using univariate and multivariate analyses. Correlation between age at IA diagnosis and age at dialysis initiation was also examined. Results  The prevalence of IA was 21.7%, with multiple IAs in 30.0% of affected patients and subarachnoid hemorrhage (SAH) in 23.3%. The most common IA locations were the internal carotid artery (35.7%), middle cerebral artery (28.6%), and anterior cerebral artery (21.4%). Patients in the IA group were older at ADPKD diagnosis (54.5±13.5 vs. 46.8±13.7 years, p<0.01) and more frequently on dialysis (60.0% vs. 34.3%, p<0.05). Multivariate analysis identified older age at ADPKD diagnosis and dialysis use as independent factors associated with IA. Among dialysis patients, age at IA diagnosis correlated positively with age at dialysis initiation (r=0.885, p<0.0001). Conclusion  IAs were detected in approximately one-fifth of ADPKD patients, particularly in those of advanced age and on dialysis. The statistically significant and positive correlation between IA diagnosis age and dialysis initiation suggests a relationship between IA development and renal function decline. Targeted IA screening, especially in elderly ADPKD patients and at the time of dialysis initiation, with periodic reimaging for high-risk individuals, may improve early detection and management.