Factors associated with cerebrovascular complications in a cohort of patients with autosomal dominant polycystic kidney disease in South Africa.

BACKGROUND

The prevalence of intracranial aneurysms (IAs) in individuals with autosomal dominant polycystic kidney disease (ADPKD) is about 6%-25%. This rate is higher than that of the general population and is associated with increased morbidity and mortality. Studies in Africa are sparse. Therefore, we aimed to describe the clinical manifestations, imaging features, and long-term prognoses of patients with cerebrovascular complications to inform screening and improve patients' awareness.

METHODS

We reviewed the records of patients with ADPKD admitted to Inkosi Albert Luthuli Central Hospital from January 2006 to June 2024. We reviewed 298 records to identify 14 patients who presented with cerebrovascular complications, including intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), unruptured intracranial aneurysms (UIAs), and spontaneous subdural haematoma (sSDH). We analysed their clinical manifestations, imaging characteristics, and outcomes.

RESULTS

The prevalence of cerebrovascular complications was 4.7%. Patients were predominantly men, and the median age at the time of the study was 45 years (range, 31-72). Black Africans and Indians/Asians were the most represented. Ten participants presented with IAs, a prevalence of 3%, of which 5 were ruptured. These presented as ICH in 2 patients, SAH in 2 patients, and concurrent ICH and SAH in 1 patient. The remaining 5 cases were unruptured. Caucasians and Indians were more likely to present with IAs and have a family history of ADPKD. Black Africans predominantly presented with sSDH (3 out of 4) of unknown aetiology. Black Africans had a reduced risk of IA. Intracranial bleeding was significantly associated with higher systolic blood pressure.

CONCLUSION

IAs and intracranial bleeds are the most common cerebrovascular events in ADPKD patients. Black Africans were less likely to present with IAs. Good blood pressure control may reduce the risk of intracranial bleeding.