title: Pulse pressure and presence of coronary artery calcification.
abstract: BACKGROUND
  Coronary calcification (CAC) is found in early stages of CKD. Pulse pressure (PP) predicts CAC in dialysis patients. This study evaluates the accuracy of PP in predicting CAC in patients not yet on dialysis (CKD patients).
  
  
  METHODS
  CKD patients (n = 388) underwent coronary calcium score (CAC score) and abdominal x-ray (n = 128) for estimating aorta calcification (AAC). Biochemistry and PP were measured every 3 and 6 months in patients with stage 4 to 5 and 2 to 3 CKD, respectively. The accuracy of PP and AAC was assessed by receiver operating characteristics analysis.
  
  
  RESULTS
  PP correlated with CAC score in the whole cohort and in patients with stages 2 to 3 and stages 4 to 5 CKD. PP >60 mmHg predicted CAC score >0 (OR: 2.14; P < 0.001), > or =100 (OR: 2.92; P < 0.001), > or =400 (OR: 6.17; P < 0.001) after multivariable adjustment. Area under the curve (AUC) was 0.626 for CAC score >0, 0.676 for score >100, and 0.746 for score >400. PP >60 mmHg reduced the rate of event-free survival. AAC was found in 58% of patients and correlated with CAC score. AUC was 0.628 for CAC score >0, 0.652 for score >100, 0.831 for score >400.
  
  
  CONCLUSIONS
  PP may identify CKD patients with subclinical CAC who need further evaluation. Accuracy of PP and AAC is nearly similar in predicting CAC. High PP indicates vessel wall alterations leading to adverse outcome.
authors.affiliation: Department of Nephrology, University Federico II., Via G Marconi, 80, 80024 Cardito, Napoli, Italy. domenicorusso51@hotmail.com
authors.forename: Domenico
authors.initials: D
authors.lastname: Russo
authors.forename: Luigi F
authors.initials: LF
authors.lastname: Morrone
authors.forename: Stefania
authors.initials: S
authors.lastname: Brancaccio
authors.forename: Paola
authors.initials: P
authors.lastname: Napolitano
authors.forename: Ermanno
authors.initials: E
authors.lastname: Salvatore
authors.forename: Rosanna
authors.initials: R
authors.lastname: Spadola
authors.forename: Massimo
authors.initials: M
authors.lastname: Imbriaco
authors.forename: Cinzia V
authors.initials: CV
authors.lastname: Russo
authors.forename: Vittorio E
authors.initials: VE
authors.lastname: Andreucci
mesh_terms: D000328:Adult; D000368:Aged; D001018:Aortic Diseases / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure; D002114:Calcinosis / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D002908:Chronic Disease; D003324:Coronary Artery Disease / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007674:Kidney Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors