In a South African ADPKD cohort, the prevalence of cerebrovascular complications was 4.7%, with intracranial aneurysms and intracranial bleeds being most common, Black Africans showing a reduced risk of IA, and intracranial bleeding significantly associated with higher systolic blood pressure.
Key Findings
Results
The prevalence of cerebrovascular complications in ADPKD patients at a South African hospital was 4.7%.
298 patient records were reviewed from Inkosi Albert Luthuli Central Hospital from January 2006 to June 2024.
14 patients were identified with cerebrovascular complications out of 298 total records.
Complications included intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH), unruptured intracranial aneurysms (UIAs), and spontaneous subdural haematoma (sSDH).
The study population was predominantly men with a median age of 45 years (range, 31–72).
Results
The prevalence of intracranial aneurysms (IAs) in this ADPKD cohort was 3%, with half of these being ruptured.
10 out of 298 patients presented with IAs, yielding a prevalence of 3%.
5 of the 10 IAs were ruptured: 2 presented as ICH, 2 as SAH, and 1 as concurrent ICH and SAH.
The remaining 5 IA cases were unruptured.
The observed IA prevalence of 3% falls below the reported general ADPKD IA prevalence range of 6%–25%.
Results
Caucasian and Indian/Asian patients were more likely to present with intracranial aneurysms and to have a family history of ADPKD.
Caucasians and Indians were identified as the groups more likely to present with IAs.
These same groups were more likely to have a family history of ADPKD.
Black Africans and Indians/Asians were the most represented racial groups in the overall cohort.
Results
Black African patients had a reduced risk of intracranial aneurysm compared to other racial groups.
Black Africans were less likely to present with IAs in this cohort.
Black Africans predominantly presented with spontaneous subdural haematoma (sSDH), accounting for 3 out of 4 sSDH cases.
The aetiology of sSDH in Black African patients was described as unknown.
Results
Intracranial bleeding was significantly associated with higher systolic blood pressure.
The association between intracranial bleeding events and higher systolic blood pressure was described as statistically significant.
This finding applied across ICH and SAH presentations.
The authors concluded that good blood pressure control may reduce the risk of intracranial bleeding in ADPKD patients.
What This Means
This research suggests that among South African patients with autosomal dominant polycystic kidney disease (ADPKD) — a genetic condition causing cysts to grow in the kidneys and other organs — about 1 in 20 (4.7%) experienced a serious complication involving the blood vessels of the brain. The most common of these complications were brain aneurysms (bulges in blood vessel walls) and bleeding in or around the brain. Notably, the rate of aneurysms found in this African cohort (3%) was lower than what is typically reported in studies from other parts of the world (6–25%), possibly reflecting real differences in risk across populations. Patients of Caucasian and Indian/Asian background were more likely to develop aneurysms and to have a family history of ADPKD, while Black African patients were less likely to have aneurysms but more commonly experienced a different type of bleeding called spontaneous subdural haematoma, whose cause remains unclear.
The study also found that higher systolic blood pressure (the top number in a blood pressure reading) was significantly linked to bleeding events in the brain. This is an important practical finding because blood pressure is something that can be managed with medication and lifestyle changes. The study was conducted at a major hospital in Durban, South Africa, over an 18-year period, and reviewed records of 298 ADPKD patients, identifying 14 with cerebrovascular complications — a relatively small group, which is a limitation to keep in mind.
This research matters because ADPKD affects people worldwide, but data from African populations are rare. The findings suggest that racial or ethnic background may influence which type of brain complication a person with ADPKD is more likely to experience, and that blood pressure control could be a key factor in preventing brain bleeding. These insights could help guide screening strategies and raise awareness among patients and clinicians caring for ADPKD patients in South Africa and similar settings.
Kapche C, Assounga A. (2026). Factors associated with cerebrovascular complications in a cohort of patients with autosomal dominant polycystic kidney disease in South Africa.. Cardiovascular journal of Africa. https://doi.org/10.5830/CVJA-2026-041