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Objectives: Although renal dysfunction is associated with the presence of atherosclerosis, little is known about the relationship between reduced estimated glomerular filtration rate (eGFR) and the presence of atherosclerosis detected by coronary computed tomographic angiography (CCTA). This study evaluated the relation of eGFR to the presence of coronary plaque and obstructive coronary artery disease (CAD) in patients with a zero or low coronary artery calcium score (CACS)., Methods: Coronary artery calcium scoring and CCTA were performed with CT scanners. Serum creatinine was measured before CCTA, and GFR was estimated. A total of 720 patients with a CACS ≤ 10 were enrolled., Results: Coronary plaque was detected in 118 patients. Of the 118 patients, 36 had a diagnosis of obstructive CAD. The multiple-adjusted odds ratios of presenting with coronary plaque and obstructive CAD were 1.82 (95% CI 1.06-3.12, p = 0.030) and 1.79 (95% CI 0.71-4.49, p = 0.217) for the lowest tertile of eGFR compared with the highest tertile, respectively., Conclusions: Lower eGFR levels were associated with the presence of coronary plaque in patients with a zero or low CACS. However, the association between eGFR and the presence of obstructive CAD was not statistically significant., (© 2013 S. Karger AG, Basel.)