Lack of impact of polycystic kidney disease on the outcome of aneurysmal subarachnoid hemorrhage: a matched case-control study

View More View Less
  • 1 Neurosurgery of NeuroCenter, Kuopio University Hospital and University of Eastern Finland, Kuopio;
  • | 2 School of Medicine, Institute of Clinical Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio;
  • | 3 Kuopio Health Center, Kuopio;
  • | 4 Neurointensive Care and
  • | 5 Department of Clinical Radiology, Kuopio University Hospital, Kuopio; and
  • | 6 Transplantation and Liver Surgery Clinic, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The authors set out to study whether autosomal dominant polycystic kidney disease (ADPKD), an established risk factor for intracranial aneurysms (IAs), affects the acute course and long-term outcome of aneurysmal subarachnoid hemorrhage (aSAH).

METHODS

The outcomes of 32 ADPKD patients with aSAH between 1980 and 2015 (median age 43 years; 50% women) were compared with 160 matched (age, sex, and year of aSAH) non-ADPKD aSAH patients in the prospectively collected Kuopio Intracranial Aneurysm Patient and Family Database.

RESULTS

At 12 months, 75% of the aSAH patients with ADPKD versus 71% of the matched-control aSAH patients without ADPKD had good outcomes (Glasgow Outcome Scale score 4 or 5). There was no significant difference in condition at admission. Hypertension had been diagnosed before aSAH in 69% of the ADPKD patients versus 27% of controls (p < 0.001). Multiple IAs were present in 44% of patients in the ADPKD group versus 25% in the control group (p = 0.03). The most common sites of ruptured IAs were the anterior communicating artery (47% vs 29%, p = 0.05) and the middle cerebral artery bifurcation (28% vs 31%), and the median size was 6.0 mm versus 8.0 mm (p = 0.02). During the median follow-up of 11 years, a second aSAH occurred in 3 of 29 (10%) ADPKD patients and in 4 of 131 (3%) controls (p = 0.11). A fatal second aSAH due to a confirmed de novo aneurysm occurred in 2 (6%) of the ADPKD patients but in none of the controls (p = 0.027).

CONCLUSIONS

The outcomes of ADPKD patients with aSAH did not differ significantly from those of matched non-ADPKD aSAH patients. ADPKD patients had an increased risk of second aSAH from a de novo aneurysm, warranting long-term angiographic follow-up.

ABBREVIATIONS

AComA = anterior communicating artery; ADPKD = autosomal dominant polycystic kidney disease; aSAH = aneurysmal subarachnoid hemorrhage; GOS = Glasgow Outcome Scale; IA = intracranial aneurysm; KUH = Kuopio University Hospital; MCA = middle cerebral artery.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Heidi J. Nurmonen: Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland. heidi.nurmonen@kuh.fi.

INCLUDE WHEN CITING Published online July 3, 2020; DOI: 10.3171/2020.4.JNS20544.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

  • 1

    Cornec-Le Gall E , Alam A , Perrone RD . Autosomal dominant polycystic kidney disease . Lancet . 2019 ;393 (10174 ):919 935 .

  • 2

    Willey CJ , Blais JD , Hall AK , et al. Prevalence of autosomal dominant polycystic kidney disease in the European Union . Nephrol Dial Transplant . 2017 ;32 (8 ):1356 1363 .

    • Search Google Scholar
    • Export Citation
  • 3

    Lanktree MB , Haghighi A , Guiard E , et al. Prevalence estimates of polycystic kidney and liver disease by population sequencing . J Am Soc Nephrol . 2018 ;29 (10 ):2593 2600 .

    • Search Google Scholar
    • Export Citation
  • 4

    Iliuta I-A , Kalatharan V , Wang K , et al. Polycystic kidney disease without an apparent family history . J Am Soc Nephrol . 2017 ;28 (9 ):2768 2776 .

    • Search Google Scholar
    • Export Citation
  • 5

    Torres VE , Harris PC , Pirson Y . Autosomal dominant polycystic kidney disease . Lancet . 2007 ;369 (9569 ):1287 1301 .

  • 6

    Shaw C , Simms RJ , Pitcher D , Sandford R . Epidemiology of patients in England and Wales with autosomal dominant polycystic kidney disease and end-stage renal failure . Nephrol Dial Transplant . 2014 ;29 (10 ):1910 1918 .

    • Search Google Scholar
    • Export Citation
  • 7

    Reule S , Sexton DJ , Solid CA , et al. ESRD from autosomal dominant polycystic kidney disease in the United States, 2001-2010 . Am J Kidney Dis . 2014 ;64 (4 ):592 599 .

    • Search Google Scholar
    • Export Citation
  • 8

    Blair HA . Tolvaptan: a review in autosomal dominant polycystic kidney disease . Drugs . 2019 ;79 (3 ):303 313 .

  • 9

    Ecder T , Schrier RW . Hypertension in autosomal-dominant polycystic kidney disease: early occurrence and unique aspects . J Am Soc Nephrol . 2001 ;12 (1 ):194 200 .

    • Search Google Scholar
    • Export Citation
  • 10

    Rinkel GJE , Algra A . Long-term outcomes of patients with aneurysmal subarachnoid haemorrhage . Lancet Neurol . 2011 ;10 (4 ):349 356 .

    • Search Google Scholar
    • Export Citation
  • 11

    van Gijn J , Kerr RS , Rinkel GJ . Subarachnoid haemorrhage . Lancet . 2007 ;369 (9558 ):306 318 .

  • 12

    Zhou Z , Xu Y , Delcourt C , et al. Is regular screening for intracranial aneurysm necessary in patients with autosomal dominant polycystic kidney disease? A systematic review and meta-analysis . Cerebrovasc Dis . 2017 ;44 (1-2 ):75 82 .

    • Search Google Scholar
    • Export Citation
  • 13

    Fick GM , Johnson AM , Hammond WS , Gabow PA . Causes of death in autosomal dominant polycystic kidney disease . J Am Soc Nephrol . 1995 ;5 (12 ):2048 2056 .

    • Search Google Scholar
    • Export Citation
  • 14

    Flahault A , Trystram D , Nataf F , et al. Screening for intracranial aneurysms in autosomal dominant polycystic kidney disease is cost-effective . Kidney Int . 2018 ;93 (3 ):716 726 .

    • Search Google Scholar
    • Export Citation
  • 15

    Rossetti S , Chauveau D , Kubly V , et al. Association of mutation position in polycystic kidney disease 1 (PKD1) gene and development of a vascular phenotype . Lancet . 2003 ;361 (9376 ):2196 2201 .

    • Search Google Scholar
    • Export Citation
  • 16

    Nurmonen HJ , Huttunen T , Huttunen J , et al. Polycystic kidney disease among 4,436 intracranial aneurysm patients from a defined population . Neurology . 2017 ;89 (18 ):1852 1859 .

    • Search Google Scholar
    • Export Citation
  • 17

    Kämäräinen OP , Huttunen J , Lindgren A , et al. Identification of potential organ donors after aneurysmal subarachnoid hemorrhage in a population-based neurointensive care in Eastern Finland . Acta Neurochir (Wien) . 2018 ;160 (8 ):1507 1514 .

    • Search Google Scholar
    • Export Citation
  • 18

    Lindgren AE , Räisänen S , Björkman J , et al. De novo aneurysm formation in carriers of saccular intracranial aneurysm disease in Eastern Finland . Stroke . 2016 ;47 (5 ):1213 1218 .

    • Search Google Scholar
    • Export Citation
  • 19

    Lindgren AE , Kurki MI , Riihinen A , et al. Hypertension predisposes to the formation of saccular intracranial aneurysms in 467 unruptured and 1053 ruptured patients in Eastern Finland . Ann Med . 2014 ;46 (3 ):169 176 .

    • Search Google Scholar
    • Export Citation
  • 20

    Huttunen J , Lindgren A , Kurki MI , et al. Antidepressant use after aneurysmal subarachnoid hemorrhage: a population-based case-control study . Stroke . 2016 ;47 (9 ):2242 2248 .

    • Search Google Scholar
    • Export Citation
  • 21

    Kotikoski S , Huttunen J , Huttunen TJ , et al. Secondary hypertension in patients with saccular intracranial aneurysm disease: a population based study . PLoS One . 2018 ;13 (10 ):e0206432 .

    • Search Google Scholar
    • Export Citation
  • 22

    Adams H , Ban VS , Leinonen V , et al. Risk of shunting after aneurysmal subarachnoid hemorrhage: a collaborative study and initiation of a consortium . Stroke . 2016 ;47 (10 ):2488 2496 .

    • Search Google Scholar
    • Export Citation
  • 23

    Kurtelius A , Kurki MI , von Und Zu Fraunberg M , et al. Saccular intracranial aneurysms in children when both parents are sporadic or familial carriers of saccular intracranial aneurysms . Neuroepidemiology . 2019 ;52 (1–2 ):47 54 .

    • Search Google Scholar
    • Export Citation
  • 24

    Levey AS , Stevens LA , Schmid CH , et al. A new equation to estimate glomerular filtration rate . Ann Intern Med . 2009 ;150 (9 ):604 612 .

    • Search Google Scholar
    • Export Citation
  • 25

    Chauveau D , Pirson Y , Verellen-Dumoulin C , et al. Intracranial aneurysms in autosomal dominant polycystic kidney disease . Kidney Int . 1994 ;45 (4 ):1140 1146 .

    • Search Google Scholar
    • Export Citation
  • 26

    Schievink WI , Torres VE , Piepgras DG , Wiebers DO . Saccular intracranial aneurysms in autosomal dominant polycystic kidney disease . J Am Soc Nephrol . 1992 ;3 (1 ):88 95 .

    • Search Google Scholar
    • Export Citation
  • 27

    Gieteling EW , Rinkel GJ . Characteristics of intracranial aneurysms and subarachnoid haemorrhage in patients with polycystic kidney disease . J Neurol . 2003 ;250 (4 ):418 423 .

    • Search Google Scholar
    • Export Citation
  • 28

    Karamanakos PN , von Und Zu Fraunberg M , Bendel S , et al. Risk factors for three phases of 12-month mortality in 1657 patients from a defined population after acute aneurysmal subarachnoid hemorrhage . World Neurosurg . 2012 ;78 (6 ):631 639 .

    • Search Google Scholar
    • Export Citation
  • 29

    Steiner T , Juvela S , Unterberg A , et al. European Stroke Organization guidelines for the management of intracranial aneurysms and subarachnoid haemorrhage . Cerebrovasc Dis . 2013 ;35 (2 ):93 112 .

    • Search Google Scholar
    • Export Citation
  • 30

    Langham J , Reeves BC , Lindsay KW , et al. Variation in outcome after subarachnoid hemorrhage: a study of neurosurgical units in UK and Ireland . Stroke . 2009 ;40 (1 ):111 118 .

    • Search Google Scholar
    • Export Citation
  • 31

    Toyoda K , Ninomiya T . Stroke and cerebrovascular diseases in patients with chronic kidney disease . Lancet Neurol . 2014 ;13 (8 ):823 833 .

    • Search Google Scholar
    • Export Citation
  • 32

    Ovbiagele B . Chronic kidney disease and risk of death during hospitalization for stroke . J Neurol Sci . 2011 ;301 (1–2 ):46 50 .

    • Search Google Scholar
    • Export Citation
  • 33

    Cagnazzo F , Gambacciani C , Morganti R , Perrini P . Intracranial aneurysms in patients with autosomal dominant polycystic kidney disease: prevalence, risk of rupture, and management. A systematic review . Acta Neurochir (Wien) . 2017 ;159 (5 ):811 821 .

    • Search Google Scholar
    • Export Citation
  • 34

    Björkman J , Frösen J , Tähtinen O , et al. Aneurysm size is the strongest risk factor for intracranial aneurysm growth in the Eastern Finnish population . Neurosurgery . 2019 ;84 (5 ):1098 1103 .

    • Search Google Scholar
    • Export Citation
  • 35

    Huttunen J , Kurki MI , von Und Zu Fraunberg M , et al. Epilepsy after aneurysmal subarachnoid hemorrhage: a population-based, long-term follow-up study . Neurology . 2015 ;84 (22 ):2229 2237 .

    • Search Google Scholar
    • Export Citation
  • 36

    Huttunen J , Lindgren A , Kurki MI , et al. Epilepsy-associated long-term mortality after aneurysmal subarachnoid hemorrhage . Neurology . 2017 ;89 (3 ):263 268 .

    • Search Google Scholar
    • Export Citation
  • 37

    Huttunen T , Riihinen A , Pukkala E , et al. Increased relative risk of lung cancer in 2,904 patients with saccular intracranial aneurysm disease in Eastern Finland . Neuroepidemiology . 2012 ;38 (2 ):93 99 .

    • Search Google Scholar
    • Export Citation
  • 38

    Paavola JT , Väntti N , Junkkari A , et al. Antipsychotic use among 1144 patients after aneurysmal subarachnoid hemorrhage: a population-based case-control study . Stroke . 2019 ;50 (7 ):1711 1718 .

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 61 61 61
Full Text Views 39 39 39
PDF Downloads 60 60 60
EPUB Downloads 0 0 0