Factors associated with early-onset intracranial aneurysms in patients with autosomal dominant polycystic kidney disease

Yusuke Ushio; Hiroshi Kataoka; Hiroyuki Akagawa; Masayo Sato; Shun Manabe; Keiko Kawachi; Shiho Makabe; Taro Akihisa; Momoko Seki; Atsuko Teraoka; Naomi Iwasa; Rie Yoshida; Ken Tsuchiya; Kosaku Nitta; Junichi Hoshino; Toshio Mochizuki

doi:10.1007/s40620-023-01866-8

Factors associated with early-onset intracranial aneurysms in patients with autosomal dominant polycystic kidney disease

J Nephrol. 2024 Feb 5. doi: 10.1007/s40620-023-01866-8. Online ahead of print.

Authors

Affiliations

¹ Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
² Department of Nephrology, Tokyo Women's Medical University, 8-1 Kawada-Cho, Shinjuku-ku, Tokyo, 162-8666, Japan. kataoka@twmu.ac.jp.
³ Tokyo Women's Medical University Institute for Integrated Medical Sciences (TIIMS), Tokyo, Japan.
⁴ Department of Blood Purification, Tokyo Women's Medical University, Tokyo, Japan.

PMID: 38315279
DOI: 10.1007/s40620-023-01866-8

Abstract

Background: Recently, the importance of attribute-based medicine has been emphasized. The effects of early-onset intracranial aneurysms on patients can be significant and long-lasting. Herein, we compared the factors associated with intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD) according to age categories (≥ 50 years, < 50 years).

Methods: We included 519 ADPKD patients, with a median age of 44 years, estimated glomerular filtration rate of 54.5 mL/min/1.73 m², and total follow-up duration of 3104 patient-years. Logistic regression analyses were performed to determine factors associated with intracranial aneurysms.

Results: Regarding the presence of intracranial aneurysm, significant interactions were identified between the age category (age ≥ 50 years), female sex (P = 0.0027 for the interaction) and hypertension (P = 0.0074 for the interaction). Female sex and hypertension were associated with intracranial aneurysm risk factors only in patients aged ≥ 50 years. The presence of intracranial aneurysm was significantly associated with chronic kidney disease (CKD) stages 4-5 (odds ratio [OR] = 3.87, P = 0.0007) and family history of intracranial aneurysm or subarachnoid hemorrhage (OR = 2.30, P = 0.0217) in patients aged < 50 years. For patients aged ≥ 50 years, in addition to the abovementioned factors [OR = 2.38, P = 0.0355 for CKD stages 4-5; OR = 3.49, P = 0.0094 for family history of intracranial aneurysm or subarachnoid hemorrhage], female sex (OR = 4.51, P = 0.0005), and hypertension (OR = 5.89, P = 0.0012) were also associated with intracranial aneurysm.

Conclusion: Kidney dysfunction and family history of intracranial aneurysm or subarachnoid hemorrhage are risk factors for early-onset intracranial aneurysm. Patients aged < 50 years with a family history of intracranial aneurysm or subarachnoid hemorrhage or with CKD stages 4-5 may be at an increased risk of early-onset intracranial aneurysm.

Keywords: Attribute-based medicine; Autosomal dominant polycystic kidney disease; Intracranial aneurysm; Juvenile-onset; Sex difference; Young stroke.