Introduction

Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic renal disorder. Its prevalence is estimated at 1:1000. In a substantial number of adult patients, ADPKD leads to end‑stage kidney disease (ESKD).¹ The median age of onset of ESKD is between 58 and 79 years, depending on the type of disease.² The clinical picture of ADPKD is not limited to the kidneys; there are numerous extrarenal manifestations of the disease, and the most dangerous are intracranial aneurysms (IAs). The prevalence of IAs in ADPKD is estimated at 11.5%,³ compared with approximately 2% in the general population.⁴ However, these data apply to the pre‑ESKD population, while studies on the prevalence of IAs in patients with ADPKD and ESKD are limited in the literature. To date, the results of a single study on a Korean population are available.⁵ According to previous studies, the incidence of IAs in ADPKD increases with age and correlates with kidney enlargement,⁶ which is recognized as a prognostic marker of progression to ESKD in ADPKD.⁷ Additionally, patients with ESKD are at a very high risk of cardiovascular complications, and ADPKD is a significant risk factor for intracranial hemorrhage among patients on dialysis⁸ and after renal transplantation.⁹ These findings led to the hypothesis that the prevalence of IAs in patients with ADPKD and ESKD is further increased. To test it, we conducted a cross‑sectional study on the prevalence of IAs in renal transplant recipients with ADPKD.

Patients and methods

Over 2500 renal transplant recipients were managed at the outpatient department of the Department of Immunology, Transplant Medicine, and Internal Diseases of the Medical University of Warsaw, Poland during the period of the study (2015–2019). Within this group, 88 patients with ADPKD were identified, and 66 of these patients accepted to participate in our study. The inclusion criteria were: the diagnosis of ADPKD, being a renal transplant recipient, age older than 18 years, lack of contraindications for magnetic resonance imaging, and signed informed consent. We decided not to exclude patients with a history of IA from our study because we sought to investigate the prevalence of IA in the entire group of renal transplant recipients with ADPKD. After inclusion to the study, 3‑dimensional time‑of‑flight magnetic resonance angiography of the brain was performed. All imaging studies were performed between January 2015, and November 2019, using the Ingenia 1.5T HP scanner (Philips Healthcare, Best, the Netherlands). Demographic and clinical parameters were obtained from medical records. All patients with suspected or diagnosed IA were referred to a neurosurgeon.

This study was conducted in accordance with the principles of the Declaration of Helsinki, and the ethics committee of the Medical University of Warsaw approved the protocol. All patients gave written informed consent for inclusion into the study.

Results

A total of 66 patients were included in the study. All included patients were Caucasians. All patients were recipients of their first renal transplant. The characteristics of the study group are presented in Table 1.