Intracranial Aneurysms Are Detected in 11.2% of Polycystic Patients Undergoing Kidney Transplant Assessment, Particularly in Tall and Hypertensive Patients

Background: The risk of developing an intracranial aneurysm (ICA) is quadrupled in autosomal dominant polycystic kidney disease (ADPKD) compared with the general population, with a prevalence of ~13%. Some risk factors have been suggested in the ADPKD population, such as family history of ICA, PKD1 genotype, smoking, hypertension and female gender. A systematic screening for ICA during the pre-transplant work-up enabled us to study (i) the prevalence and (ii) the risk factors for ICA in ADPKD patients with end-stage renal disease (ESRD). Methods: The presence of an ICA was systematically sought in all ADPKD patients undergoing a pre-transplant work-up between 01/2002 and 12/2023 in our center. The clinical, genetic and radiological parameters, as well as comorbidities, were statistically compared between the 2 groups of patients with versus without ICA, with an uncertainty level of 5%. Results: Our cohort included 169 patients, 81 of whom were women (47.9%). The median age at first dialysis and at transplantation was 52.4 [46.7; 62.7] and 54.8 [49.1; 64.1] years respectively. There were 27 pre-emptive transplants, and 30 patients still on the waiting list. Median body mass index was 25.9 [23.1; 29.2] kg/m2. Hypertension and/or diabetes were diagnosed in 167 (98.8%) and 57 (33.7%) patients, respectively. The median age at diagnosis of hypertension was 41.4 [31.3; 50.4] years. Left ventricular hypertrophy was detected in 75 patients (46%). Smoking was found in 98 (58%) patients. A family history of ICA was reported in 35 patients (23%). Molecular confirmation of PRAD was carried out in 57 patients, 43 of whom had a PKD1 variant, 8 PKD2 and 6 others. In this cohort of 169 transplant candidates with ADPKD, the prevalence of ICA reached 11.2%. These 19 patients with ICA were significantly taller than ICA-negative patients: 176 ± 9 vs 170 ± 9 cm, p=0.015. Blood pressure levels were significantly higher in ICA-positive patients (systolic: 152 ± 15 vs 136 ± 18 mmHg, p=0.0002; diastolic: 86 ± 11 vs 81 ± 12 mmHg, p=0.11). Conclusion: ICA is a frequent complication of ADPKD, which is associated with higher height and systolic hypertension. The other above-mentioned risk factors were not statistically confirmed in our retrospective monocentric cohort including ESRD patients.