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Pulse Pressure and Presence of Coronary Artery Calcification

Domenico Russo^*, Luigi F. Morrone, Stefania Brancaccio^*, Paola Napolitano^*, Ermanno Salvatore, Rosanna Spadola^*, Massimo Imbriaco, Cinzia V. Russo^*, and Vittorio E. Andreucci^*

Departments of ^* Nephrology and Radiology, University Federico II, Naples, and Ospedale G. Rummo Benevento, Italy

Correspondence: Dr. Domenico Russo, Department of Nephrology, University Federico II., Via G Marconi, 80, 80024 Cardito, Napoli, Italy. Phone: 00 39 (0) 81 7464305; Fax: 00 30 (0) 81 7464305; E-mail: domenicorusso51{at}hotmail.com

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), 100 (OR: 2.92; P < 0.001), 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.

Conclusion: 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.