University of Bern, Bern, Switzerland.
Denver Nephrologists, Denver, Colorado.
Clin J Am Soc Nephrol. 2017 Feb 7;12(2):315-322. doi: 10.2215/CJN.04720416. Epub 2016 Dec 9.
Patients receiving hemodialysis are at risk of cardiovascular events. A novel blood test (T test) determines the individual calcification propensity of blood.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: T 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 T results 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 T. 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 T was independently associated with a higher risk of the primary composite end point as a continuous measure (hazard ratio [HR] per 1 SD lower T, 1.15; 95% confidence interval [95% CI], 1.08 to 1.22; P<0.001). Furthermore, lower T was associated with a higher risk in all-cause mortality (HR per 1 SD lower T, 1.10; 95% CI, 1.02 to 1.17; P=0.001), MI (HR per 1 SD lower T, 1.38; 95% CI, 1.19 to 1.60; P<0.001), and PVE (HR per 1 SD lower T, 1.22; 95% CI, 1.05 to 1.42; P=0.01). T improved 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 T-guided therapies improve outcomes.
接受血液透析的患者存在心血管事件风险。一种新型血液检测（T 测试）可确定血液的个体钙化倾向。
设计、设置、参与者和测量方法：在接受依卡路特治疗降低心血管事件的评估（EVOLVE）试验的 2785 例基线血液透析患者的血清样本中测定 T，将 T 结果与患者结局相关联。
血清白蛋白、碳酸氢盐、高密度脂蛋白胆固醇和肌酐是与 T 呈正相关/直接相关的主要因素，而磷酸盐是与 T 呈负相关/间接相关的主要因素。在中位随访时间 619 天后，1350 例患者达到主要复合终点（全因死亡率、心肌梗死[MI]、不稳定型心绞痛住院、心力衰竭或外周血管事件[PVE]）。经混杂因素校正后，T 较低与主要复合终点的风险增加独立相关，呈连续测量（每降低 1 个标准差 T 的风险比[HR]，1.15；95%置信区间[95%CI]，1.08 至 1.22；P<0.001）。此外，T 较低与全因死亡率（每降低 1 个标准差 T 的 HR，1.10；95%CI，1.02 至 1.17；P=0.001）、MI（每降低 1 个标准差 T 的 HR，1.38；95%CI，1.19 至 1.60；P<0.001）和 PVE（每降低 1 个标准差 T 的 HR，1.22；95%CI，1.05 至 1.42；P=0.01）风险增加相关。T 提高了主要复合终点（综合鉴别改善和净重新分类改善，P<0.001 和 P=0.001）的风险预测。前瞻性试验应阐明 T 指导治疗是否改善结局。
