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End-stage renal disease (ESRD) is characterized by a very high rate of cardiovascular events that warrants thorough screening for coronary atherosclerosis, especially in patients undergoing a kidney transplant. Therefore, we assessed the diagnostic performance of 64-slice multidetector coronary computed tomographic angiography (CCTA) in patients with ESRD.We included patients who had been referred for a CCTA and an invasive coronary angiography (diagnostic standard) within 6 months, either as part of clinical work-up in two urban medical centers or as part of the multicenter ACCURACY trial.Thirty-one ESRD patients were included and compared with 588 non-ESRD patients undergoing CCTA and invasive coronary angiography. On a patient-based model, the sensitivity, specificity, and positive and negative predictive values to detect at least 50% and at least 70% stenosis were 100, 78, 92, and 100% and 100, 91, 95, and 100%, respectively, for ESRD patients and 97, 83, 87, and 96% and 94, 87, 85, and 95%, respectively, for non-ESRD controls. There were no statistically significant differences between ESRD and non-ESRD participants in diagnostic performance measures.Results show 64-row multidetector CCTA is highly sensitive and specific in the detection of coronary artery stenosis irrespective of ESRD. Our findings suggest that CCTA is a promising diagnostic tool for the timely detection and/or exclusion of coronary atherosclerosis in patients undergoing pretransplant cardiovascular surveillance.