Middle cerebral artery aneurysms in older women with autosomal dominant polycystic kidney disease.

BACKGROUND

Sex and age impact on intracranial aneurysms (IAs) in patients with autosomal dominant polycystic kidney disease (ADPKD) remains unclear. We explored IA characteristics in patients with ADPKD using sex- and age-based cross-classification methods.

METHODS

We retrospectively reviewed the medical records of 586 outpatients with ADPKD who visited the Kidney Centre at Tokyo Women's Medical University Hospital between July 2003 and July 2019. After excluding 67 patients, 519 were included in the final analysis. The associations of IA with sex, age, hypertension, family history of IA/subarachnoid haemorrhage (SAH), chronic kidney disease (CKD) stages and kidney volume were examined.

RESULTS

Significant sex differences were found in patients with IA. Women had a higher distribution of anterior circulation IAs, including middle cerebral artery (MCA) aneurysms (62.7% versus 44.8%), and experienced SAH at an older age (46 versus 37.5 years) than men. In sex-specific analyses, CKD stages IV and V and family history of IA/SAH were associated with IA in men and women; however, hypertension was associated with IA only in women. When IAs were cross-classified by sex and age (≥50 years), significant differences were observed, particularly in the MCA, where women ≥50 years of age had a higher distribution than men [40.5% versus 5.9%; odds ratio (OR) 10.88]. These location-specific differences were not observed in patients <50 years of age. Analyses of ageing effects in patients with ADPKD revealed that compared with men, women ≥50 years of age had a higher risk of hypertension (OR 4.11) and MCA aneurysms (OR 5.93) than those <50 years of age. MCA aneurysms in women ≥50 years of age were associated with hypertension (OR 8.27).

CONCLUSION

Sex and age significantly affect IA development in patients with ADPKD, highlighting the significance of hypertension in older women at risk of MCA aneurysms.