Blood Calcification Propensity, Cardiovascular Events, and Survival in Patients Receiving Hemodialysis in the EVOLVE Trial

Clin J Am Soc Nephrol. 2017 Feb 7;12(2):315-322. doi: 10.2215/CJN.04720416. Epub 2016 Dec 9.


Background and objectives: Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (T50 test) determines the individual calcification propensity of blood.

Design, setting, participants, & measurements: T50 was 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 T50 results were related to patient outcomes.

Results: 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 T50 was 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 T50 was 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). T50 improved risk prediction (integrated discrimination improvement and net reclassification improvement, P<0.001 and P=0.001) of the primary composite end point.

Conclusions: 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.

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.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Angina, Unstable / blood
  • Angina, Unstable / epidemiology
  • Calcimimetic Agents / therapeutic use
  • Calcinosis / blood*
  • Cardiovascular Diseases / blood*
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / therapy
  • Cause of Death*
  • Cinacalcet / therapeutic use
  • Female
  • Heart Failure / blood
  • Heart Failure / epidemiology
  • Hematologic Tests
  • Hospitalization / statistics & numerical data
  • Humans
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Myocardial Infarction / blood
  • Myocardial Infarction / epidemiology
  • Peripheral Vascular Diseases / blood
  • Peripheral Vascular Diseases / epidemiology
  • Peripheral Vascular Diseases / surgery
  • Predictive Value of Tests
  • Prospective Studies
  • Renal Dialysis*
  • Survival Rate


  • Calcimimetic Agents
  • Cinacalcet