{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:29:36Z","timestamp":1791851376809,"version":"4.3.4"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2017,2]]},"abstract":"\n Background and objectives<\/jats:title>\n \n Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (\n T<\/jats:italic>\n 50<\/jats:sub>\n test) determines the individual calcification propensity of blood.\n <\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n \n T<\/jats:italic>\n 50<\/jats:sub>\n 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\n T<\/jats:italic>\n 50<\/jats:sub>\n results were related to patient outcomes.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Serum albumin, bicarbonate, HDL cholesterol, and creatinine were the main factors positively\/directly and phosphate was the main factor negatively\/inversely associated with\n T<\/jats:italic>\n 50<\/jats:sub>\n . 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\n T<\/jats:italic>\n 50<\/jats:sub>\n was independently associated with a higher risk of the primary composite end point as a continuous measure (hazard ratio [HR] per 1 SD lower\n T<\/jats:italic>\n 50<\/jats:sub>\n , 1.15; 95% confidence interval [95% CI], 1.08 to 1.22;\n P<\/jats:italic>\n <0.001). Furthermore, lower\n T<\/jats:italic>\n 50<\/jats:sub>\n was associated with a higher risk in all-cause mortality (HR per 1 SD lower\n T<\/jats:italic>\n 50<\/jats:sub>\n , 1.10; 95% CI, 1.02 to 1.17;\n P<\/jats:italic>\n =0.001), MI (HR per 1 SD lower\n T<\/jats:italic>\n 50<\/jats:sub>\n , 1.38; 95% CI, 1.19 to 1.60;\n P<\/jats:italic>\n <0.001), and PVE (HR per 1 SD lower\n T<\/jats:italic>\n 50<\/jats:sub>\n , 1.22; 95% CI, 1.05 to 1.42;\n P<\/jats:italic>\n =0.01).\n T<\/jats:italic>\n 50<\/jats:sub>\n improved risk prediction (integrated discrimination improvement and net reclassification improvement,\n P<\/jats:italic>\n <0.001 and\n P<\/jats:italic>\n =0.001) of the primary composite end point.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n 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\n T<\/jats:italic>\n 50<\/jats:sub>\n -guided therapies improve outcomes.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.04720416","type":"journal-article","created":{"date-parts":[[2016,12,9]],"date-time":"2016-12-09T22:21:54Z","timestamp":1481322114000},"page":"315-322","source":"Crossref","is-referenced-by-count":143,"title":["Blood Calcification Propensity, Cardiovascular Events, and Survival in Patients Receiving Hemodialysis in the EVOLVE Trial"],"prefix":"10.2215","volume":"12","author":[{"given":"Andreas","family":"Pasch","sequence":"first","affiliation":[{"name":"University of Bern, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoffrey A.","family":"Block","sequence":"additional","affiliation":[{"name":"Denver Nephrologists, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Bachtler","sequence":"additional","affiliation":[{"name":"University of Bern, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R.","family":"Smith","sequence":"additional","affiliation":[{"name":"The Royal Melbourne Hospital, Victoria, Melbourne, Australia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilhelm","family":"Jahnen-Dechent","sequence":"additional","affiliation":[{"name":"Rheinisch-Westfaelische Technische Hochschule University of Aachen, Aachen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spyridon","family":"Arampatzis","sequence":"additional","affiliation":[{"name":"University of Bern, Bern, Switzerland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenn M.","family":"Chertow","sequence":"additional","affiliation":[{"name":"Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Parfrey","sequence":"additional","affiliation":[{"name":"Health Sciences Center, St. John\u2019s, Newfoundland, Canada; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoye","family":"Ma","sequence":"additional","affiliation":[{"name":"Amgen, Thousand Oaks, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juergen","family":"Floege","sequence":"additional","affiliation":[{"name":"Rheinisch-Westfaelische Technische Hochschule University of Aachen, Aachen, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2016,12,9]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1056\/NEJMoa041031","article-title":"Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.","volume":"351","author":"Go","year":"2004","journal-title":"N Engl J Med"},{"issue":"Suppl 3","key":"B2-20230813","doi-asserted-by":"crossref","first-page":"S112","DOI":"10.1053\/ajkd.1998.v32.pm9820470","article-title":"Clinical epidemiology of cardiovascular disease in chronic renal disease.","volume":"32","author":"Foley","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/j.1440-1797.2008.00982.x","article-title":"Are traditional risk factors valid for assessing cardiovascular risk in end-stage renal failure patients?","volume":"13","author":"Shah","year":"2008","journal-title":"Nephrology (Carlton)"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1111\/nep.12094","article-title":"Performance of the Framingham risk score in patients receiving hemodialysis.","volume":"18","author":"Huang","year":"2013","journal-title":"Nephrology (Carlton)"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"2208","DOI":"10.1097\/01.ASN.0000133041.27682.A2","article-title":"Mineral metabolism, mortality, and morbidity in maintenance hemodialysis.","volume":"15","author":"Block","year":"2004","journal-title":"J Am Soc Nephrol"},{"key":"B6-20230813","doi-asserted-by":"crossref","first-page":"996","DOI":"10.1038\/ki.2014.419","article-title":"Development and validation of a predictive mortality risk score from a European hemodialysis cohort.","volume":"87","author":"Floege","year":"2015","journal-title":"Kidney Int"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"450","DOI":"10.2215\/CJN.01870408","article-title":"Low bone volume--a risk factor for coronary calcifications in hemodialysis patients.","volume":"4","author":"Adragao","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"issue":"113","key":"B8-20230813","first-page":"S1","article-title":"KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD).","year":"2009","journal-title":"Kidney Int Suppl"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"2131","DOI":"10.1681\/ASN.V12102131","article-title":"Association of elevated serum PO(4), Ca x PO(4) product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients.","volume":"12","author":"Ganesh","year":"2001","journal-title":"J Am Soc Nephrol"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1053\/ajkd.1998.v31.pm9531176","article-title":"Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: A national study.","volume":"31","author":"Block","year":"1998","journal-title":"Am J Kidney Dis"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1681\/ASN.2004070602","article-title":"Serum phosphate levels and mortality risk among people with chronic kidney disease.","volume":"16","author":"Kestenbaum","year":"2005","journal-title":"J Am Soc Nephrol"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1681\/ASN.2008040349","article-title":"Association of serum phosphate with vascular and valvular calcification in moderate CKD.","volume":"20","author":"Adeney","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1093\/ndt\/13.8.2037","article-title":"Cardiac valve calcification in haemodialysis patients: Role of calcium-phosphate metabolism.","volume":"13","author":"Ribeiro","year":"1998","journal-title":"Nephrol Dial Transplant"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1056\/NEJM200005183422003","article-title":"Coronary-artery calcification in young adults with end-stage renal disease who are undergoing dialysis.","volume":"342","author":"Goodman","year":"2000","journal-title":"N Engl J Med"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1007\/s00467-008-1038-0","article-title":"Progression of coronary calcification in pediatric chronic kidney disease stage 5.","volume":"24","author":"Civilibal","year":"2009","journal-title":"Pediatr Nephrol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1111\/j.1542-4758.2009.00423.x","article-title":"Impact of coronary artery calcification in hemodialysis patients: Risk factors and associations with prognosis.","volume":"14","author":"Ohtake","year":"2010","journal-title":"Hemodial Int"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1161\/hy1001.096358","article-title":"Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease.","volume":"38","author":"Blacher","year":"2001","journal-title":"Hypertension"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1053\/j.ajkd.2012.06.018","article-title":"Associations between coronary calcification on chest radiographs and mortality in hemodialysis patients.","volume":"60","author":"Abdelmalek","year":"2012","journal-title":"Am J Kidney Dis"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/j.1542-4758.2012.00700.x","article-title":"Left ventricular mass index and aortic arch calcification score are independent mortality predictors of maintenance hemodialysis patients.","volume":"16","author":"Liu","year":"2012","journal-title":"Hemodial Int"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"654","DOI":"10.2215\/CJN.07450714","article-title":"Vascular calcification in patients with nondialysis CKD over 3 years.","volume":"10","author":"G\u00f3rriz","year":"2015","journal-title":"Clin J Am Soc Nephrol"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1681\/ASN.2012030240","article-title":"Nanoparticle-based test measures overall propensity for calcification in serum.","volume":"23","author":"Pasch","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1681\/ASN.2013060635","article-title":"Serum calcification propensity predicts all-cause mortality in predialysis CKD.","volume":"25","author":"Smith","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1681\/ASN.2014070670","article-title":"Calcification propensity and survival among renal transplant recipients.","volume":"27","author":"Keyzer","year":"2016","journal-title":"J Am Soc Nephrol"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"2482","DOI":"10.1056\/NEJMoa1205624","article-title":"Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis.","volume":"367","author":"Chertow","year":"2012","journal-title":"N Engl J Med"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"2872","DOI":"10.1093\/ndt\/gfr777","article-title":"Baseline characteristics of subjects enrolled in the Evaluation of Cinacalcet HCl Therapy to Lower Cardiovascular Events (EVOLVE) trial.","volume":"27","author":"Chertow","year":"2012","journal-title":"Nephrol Dial Transplant"},{"key":"B26-20230813","doi-asserted-by":"crossref","first-page":"898","DOI":"10.2215\/CJN.04381206","article-title":"Evaluation of Cinacalcet Therapy to Lower Cardiovascular Events (EVOLVE): rationale and design overview.","volume":"2","author":"Chertow","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"1501","DOI":"10.1002\/sim.4780091214","article-title":"Relation of pooled logistic regression to time dependent Cox regression analysis: The Framingham Heart Study.","volume":"9","author":"D\u2019Agostino","year":"1990","journal-title":"Stat Med"},{"key":"B28-20230813","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1002\/sim.2929","article-title":"Evaluating the added predictive ability of a new marker: From area under the ROC curve to reclassification and beyond.","volume":"27","author":"Pencina","year":"2008","journal-title":"Stat Med"},{"key":"B29-20230813","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1681\/ASN.V83475","article-title":"Reassessing the cardiac risk profile in chronic hemodialysis patients: A hypothesis on the role of oxidant stress and other non-traditional cardiac risk factors.","volume":"8","author":"Becker","year":"1997","journal-title":"J Am Soc Nephrol"},{"key":"B30-20230813","doi-asserted-by":"crossref","first-page":"3568","DOI":"10.1093\/ndt\/gfm424","article-title":"Factors associated with mortality in patients new to haemodialysis.","volume":"22","author":"Spiegel","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"B31-20230813","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1093\/ndt\/gfq582","article-title":"Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients.","volume":"26","author":"Noordzij","year":"2011","journal-title":"Nephrol Dial Transplant"},{"key":"B32-20230813","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1093\/ndt\/gfh125","article-title":"Determinants of progressive vascular calcification in haemodialysis patients.","volume":"19","author":"Chertow","year":"2004","journal-title":"Nephrol Dial Transplant"},{"key":"B33-20230813","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/j.1744-9987.2011.01054.x","article-title":"Correlation of coronary artery calcification with pre-hemodialysis bicarbonate levels in patients on hemodialysis.","volume":"16","author":"Oka","year":"2012","journal-title":"Ther Apher Dial"},{"key":"B34-20230813","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/S0272-6386(04)00936-9","article-title":"Association of predialysis serum bicarbonate levels with risk of mortality and hospitalization in the Dialysis Outcomes and Practice Patterns Study (DOPPS).","volume":"44","author":"Bommer","year":"2004","journal-title":"Am J Kidney Dis"},{"key":"B35-20230813","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.2215\/CJN.02190507","article-title":"Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease.","volume":"2","author":"Sigrist","year":"2007","journal-title":"Clin J Am Soc Nephrol"},{"key":"B36-20230813","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1053\/j.jrn.2008.08.003","article-title":"Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition.","volume":"19","author":"de Mutsert","year":"2009","journal-title":"J Ren Nutr"},{"key":"B37-20230813","doi-asserted-by":"crossref","first-page":"1748","DOI":"10.1161\/CIRCULATIONAHA.108.783738","article-title":"Dialysis accelerates medial vascular calcification in part by triggering smooth muscle cell apoptosis.","volume":"118","author":"Shroff","year":"2008","journal-title":"Circulation"},{"key":"B38-20230813","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.1021\/j100638a011","article-title":"Conversion of amorphous calcium phosphate to microcrystalline hydroxyapatite. A pH-dependent, solution-mediated, solid-solid conversion.","volume":"77","author":"Boskey","year":"1973","journal-title":"J Phys Chem"},{"key":"B39-20230813","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1007\/BF02010752","article-title":"A thermodynamic analysis of the amorphous to crystalline calcium phosphate transformation.","volume":"25","author":"Meyer","year":"1978","journal-title":"Calcif Tissue Res"},{"key":"B40-20230813","doi-asserted-by":"crossref","first-page":"13333","DOI":"10.1074\/jbc.M210868200","article-title":"Structural basis of calcification inhibition by alpha 2-HS glycoprotein\/fetuin-A. Formation of colloidal calciprotein particles.","volume":"278","author":"Heiss","year":"2003","journal-title":"J Biol Chem"},{"key":"B41-20230813","doi-asserted-by":"crossref","first-page":"14815","DOI":"10.1074\/jbc.M709938200","article-title":"Hierarchical role of fetuin-A and acidic serum proteins in the formation and stabilization of calcium phosphate particles.","volume":"283","author":"Heiss","year":"2008","journal-title":"J Biol Chem"},{"key":"B42-20230813","doi-asserted-by":"crossref","first-page":"e116273","DOI":"10.1371\/journal.pone.0116273","article-title":"Magnesium modifies the cardiovascular mortality risk associated with hyperphosphatemia in patients undergoing hemodialysis: A cohort study.","volume":"9","author":"Sakaguchi","year":"2014","journal-title":"PLoS One"},{"key":"B43-20230813","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1111\/ajt.13443","article-title":"Serum calcification propensity is a strong and independent determinant of cardiac and all-cause mortality in kidney transplant recipients.","volume":"16","author":"Dahle","year":"2016","journal-title":"Am J Transplant"},{"key":"B44-20230813","doi-asserted-by":"crossref","first-page":"2504","DOI":"10.1681\/ASN.2014070714","article-title":"Cause of death in patients with reduced kidney function.","volume":"26","author":"Thompson","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"B45-20230813","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1056\/NEJMoa021583","article-title":"Effect of dialysis dose and membrane flux in maintenance hemodialysis.","volume":"347","author":"Eknoyan","year":"2002","journal-title":"N Engl J Med"},{"key":"B46-20230813","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1056\/NEJMoa043545","article-title":"Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis.","volume":"353","author":"Wanner","year":"2005","journal-title":"N Engl J Med"},{"key":"B47-20230813","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1053\/j.ajkd.2007.12.002","article-title":"A comparison of sevelamer and calcium-based phosphate binders on mortality, hospitalization, and morbidity in hemodialysis: A secondary analysis of the Dialysis Clinical Outcomes Revisited (DCOR) randomized trial using claims data.","volume":"51","author":"St Peter","year":"2008","journal-title":"Am J Kidney Dis"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201702000-00015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:36:28Z","timestamp":1786368988000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201702000-00015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,12,9]]},"references-count":47,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.04720416","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,12,9]]}}}