Sex Differences and Aging Influence the Association between Kidney Prognosis and Intracranial Aneurysms in Patients with ADPKD: Attribute-Based Medicine (ABM) Insights

Background: There is a recognized tendency for intracranial aneurysms (IAs) to occur more frequently in elderly women. We aimed to elucidate the association of IAs on kidney disease progression in ADPKD patients, taking into account age and sex as pivotal factors. Methods: Our study included 494 patients with ADPKD. Renal outcome, defined as a 50% reduction in estimated glomerular filtration rate or initiation of renal replacement therapy, was evaluated using Cox regression analysis and Kaplan-Meier analysis. Results: Multivariable Cox analyses indicated that IAs were significantly associated with kidney disease progression across the entire cohort (hazard ratio [HR]=1.93). Sub-group analyses showed significant associations between IAs and kidney disease progression in men with <50 years (HR=3.93) and in women ≥50 years (HR=3.63). Kaplan–Meier analysis demonstrated that kidney survival rates were significantly lower in patients with IAs compared to those without, across all cohorts. The 5-year renal survival rate of ADPKD patients with IAs was 51.2% for the entire cohort, 73.5% for women <50 years, 46.2% for men <50 years, 39.9% for women ≥50 years, and 37.5% for men ≥50 years, indicating a extremely poor renal prognosis. Conclusion: IAs were associated with a poor renal prognosis in patients with ADPKD, especially in men <50 years and women ≥50 years. Susceptibility to IAs in ADPKD patients varies by age and sex. Younger patients are primarily affected by genetic mutations, while older patients, particularly elderly women, may be influenced by a combination of genetic mutations and lifestyle factors, potentially impacting their kidney prognosis.