title: Blood Calcification Propensity, Cardiovascular Events, and Survival in Patients Receiving Hemodialysis in the EVOLVE Trial.
abstract: Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (T50test) determines the individual calcification propensity of blood.
  
  
  
  T50was determined in 2785 baseline serum samples of patients receiving hemodialysis enrolled in the Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE) trial and the T50results were related to patient outcomes.
  
  
  
  Serum albumin, bicarbonate, HDL cholesterol, and creatinine were the main factors positively/directly and phosphate was the main factor negatively/inversely associated with T50. The primary composite end point (all-cause mortality, myocardial infarction [MI], hospitalization for unstable angina, heart failure, or peripheral vascular event [PVE]) was reached in 1350 patients after a median follow-up time of 619 days. After adjustments for confounding, a lower T50was independently associated with a higher risk of the primary composite end point as a continuous measure (hazard ratio [HR] per 1 SD lower T50, 1.15; 95% confidence interval [95% CI], 1.08 to 1.22; P<0.001). Furthermore, lower T50was associated with a higher risk in all-cause mortality (HR per 1 SD lower T50, 1.10; 95% CI, 1.02 to 1.17; P=0.001), MI (HR per 1 SD lower T50, 1.38; 95% CI, 1.19 to 1.60; P<0.001), and PVE (HR per 1 SD lower T50, 1.22; 95% CI, 1.05 to 1.42; P=0.01). T50improved risk prediction (integrated discrimination improvement and net reclassification improvement, P<0.001 and P=0.001) of the primary composite end point.
  
  
  
  Blood calcification propensity was independently associated with the primary composite end point, all-cause mortality, MI, and PVE in the EVOLVE study and improved risk prediction. Prospective trials should clarify whether T50-guided therapies improve outcomes.
authors.affiliation: University of Bern, Bern, Switzerland.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pasch
authors.affiliation: Denver Nephrologists, Denver, Colorado.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Block
authors.affiliation: University of Bern, Bern, Switzerland.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bachtler
authors.affiliation: The Royal Melbourne Hospital, Victoria, Melbourne, Australia.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Smith
authors.affiliation: Rheinisch-Westfaelische Technische Hochschule University of Aachen, Aachen, Germany.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Jahnen-Dechent
authors.affiliation: University of Bern, Bern, Switzerland.
authors.forename: Spyridon
authors.initials: S
authors.lastname: Arampatzis
authors.affiliation: Stanford University School of Medicine, Palo Alto, California.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Chertow
authors.affiliation: Health Sciences Center, St. John's, Newfoundland, Canada; and.
authors.forename: Patrick
authors.initials: P
authors.lastname: Parfrey
authors.affiliation: Amgen, Thousand Oaks, California.
authors.forename: Xiaoye
authors.initials: X
authors.lastname: Ma
authors.affiliation: Rheinisch-Westfaelische Technische Hochschule University of Aachen, Aachen, Germany.
authors.forename: Juergen
authors.initials: J
authors.lastname: Floege
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood / Q000453:epidemiology; D057966:Calcimimetic Agents / Q000627:therapeutic use; D002114:Calcinosis / Q000097:blood*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000453:epidemiology* / Q000628:therapy; D002423:Cause of Death; D000069449:Cinacalcet / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology; D006403:Hematologic Tests; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000097:blood / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D011446:Prospective Studies; D006435:Renal Dialysis; D015996:Survival Rate
chemical_list: D057966:Calcimimetic Agents; D000069449:Cinacalcet
keywords: CPP; EVOLVE; T50; angina, unstable; bicarbonates; calcification propensity; calciprotein particles; cholesterol, HDL; cinacalcet hydrochloride; creatinine; follow-up studies; heart failure; hematologic tests; hemodialysis; hospitalization; humans; myocardial infarction; phosphates; prospective studies; renal dialysis; serum albumin