Development of a prediction model for aneurysmal events to guide imaging surveillance in autosomal dominant polycystic kidney disease

OBJECTIVE Patients with autosomal dominant polycystic kidney disease (ADPKD) face a higher prevalence of intracranial aneurysms. However, the risk factors for aneurysmal events—particularly subarachnoid hemorrhage (SAH) or aneurysm growth, morphological changes, or de novo formation—remain poorly understood, leading to a lack of standardized policy of follow-up. This study aimed to identify predictors of such high-risk events and develop a risk prediction model to guide follow-up strategies. METHODS This retrospective cohort study was conducted at 2 ADPKD referral centers in Japan. A total of 1267 adult patients with ADPKD who underwent brain imaging between 2003 and 2024 at 2 Japanese referral centers were eligible, and 132 patients with untreated intracranial aneurysms and follow-up imaging were finally included. The primary outcome was the composite of aneurysm growth, morphological change, de novo formation, or rupture. A multivariable logistic regression analysis was used to pick up variants for prediction model. Internal validation was performed in a validation cohort of 638 patients and also via bootstrapping (n = 2000). RESULTS Multiple aneurysms (OR 5.56, p CONCLUSIONS The authors developed an internally validated, easily applicable risk score for predicting aneurysm-related events in ADPKD patients. Generalization requires caution because of potential selection bias, and external validation is warranted.