NEPHROLOGY – ORIGINAL PAPER Hypervolemia rather than arterial calcification and extracoronary atherosclerosis is the main determinant of pulse pressure in hemodialysis patients Halil Yazici • Huseyin Oflaz • Hamdi Pusuroglu • Savas Tepe • Cengiz Dogan • Ali Basci • Vakur Akkaya • Alaattin Yildiz Received: 17 February 2011 / Accepted: 13 June 2011 / Published online: 5 July 2011 Ó Springer Science+Business Media, B.V. 2011 Abstract Introduction Pulse pressure (PP) has been reported as an independent predictor of cardiovascular mor- tality in hemodialysis patients. In this study, we aimed to investigate association of PP with echocar- diographic and vascular structural changes such as atherosclerosis and arterial calcifications in HD patients. Patients and 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 calci- fication (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. Conclusion PP was weakly associated with large vessel calcification and atherosclerosis in hemodial- ysis patients. The bulk of the effect on PP seems to be due to hypervolemia. Keywords Pulse pressure  EBCT  High-resolution Doppler ultrasonography  Atherosclerosis  Arterial calcification H. Yazici  A. Yildiz (&) Division of Nephrology, Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Capa, Topkapi, Istanbul e-mail: alaattiny@hotmail.com; yildiza@istanbul.edu.tr H. Oflaz Department of Cardiology, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey H. Pusuroglu  V. Akkaya Department of Internal Medicine, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey S. Tepe TEST Radiology Center, Istanbul, Turkey C. Dogan  A. Basci Fresenius Medical Care, Istanbul, Turkey 123 Int Urol Nephrol (2012) 44:1203–1210 DOI 10.1007/s11255-011-0024-9