title: Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients.
abstract: BACKGROUND
  Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mortality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocardiographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients.
  
  
  METHODS
  In this cross-sectional study, 108 chronic hemodialysis patients (49 male, 59 female, mean age: 46 ± 13 years) were included. Biochemical analyses, echocardiographic and high-resolution carotid Doppler examinations were done. Aortic wall and coronary artery calcifications were measured with electron beam computed tomography. The degree of carotid artery stenosis was measured at four different sites (communis, bulbus, interna and externa) in both carotid arteries.
  
  
  RESULTS
  PP was strongly correlated with systolic (r: 0.82) and diastolic (r: 0.33) blood pressure, left ventricular mass index (r: 0.58), left ventricle end diastolic diameter (r: 0.38) and weakly correlated with aortic wall calcification score (r: 0.26) and carotid plaque score (r: 0.27), but not with coronary artery calcification score. Patients with carotid plaque had higher PP than patients without plaque (50 ± 16 mmHg versus 44 ± 14 mmHg, P = 0.05). Patients were divided into three groups according to aortic wall calcification score. PP was significantly higher in patients with higher aortic wall calcification (54 ± 16 mmHg) than patients with lower aortic wall calcification (44 ± 15 mmHg, P = 0.04). However, on multivariate linear regression analysis for predicting PP, the only significant factor retained was left ventricle end diastolic diameter.
  
  
  CONCLUSIONS
  PP was weakly associated with large vessel calcification and atherosclerosis in hemodialysis patients. The bulk of the effect on PP seems to be due to hypervolemia.
authors: Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Capa, Topkapi, Istanbul.
authors: Halil
authors: H
authors: Yazici
authors: Huseyin
authors: H
authors: Oflaz
authors: Hamdi
authors: H
authors: Pusuroglu
authors: Savas
authors: S
authors: Tepe
authors: Cengiz
authors: C
authors: Dogan
authors: Ali
authors: A
authors: Basci
authors: Vakur
authors: V
authors: Akkaya
authors: Alaattin
authors: A
authors: Yildiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D001794:Blood Pressure / Q000502:physiology*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014421:Turkey / Q000453:epidemiology; D061205:Vascular Calcification / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult