DOCTOR INFO
ASSESS AND IMPROVE
CALCIFICATION-RELATED CARDIOVASCULAR RISK
IN CKD 5/5D PATIENTS
CALCIFICATION-RELATED CARDIOVASCULAR RISK
IN CKD 5/5D PATIENTS
T50
• detects patients at risk of
calcification-related CV events
• guides therapy
• monitors treatment success
• detects patients at risk of
calcification-related CV events
• guides therapy
• monitors treatment success
CALCIFICATION IN DIALYSIS PATIENTS
Dialysis patients are at exceptional risk of accelerated vascular calcifications. Today, only parts of the blood's calcification system can be measured (e.g., calcium and phosphate). This lack of an overall picture may have resulted in suboptimal therapy guidance.
As a consequence, dialysis patients have remained at very high risk for heart attacks, peripheral artery disease, strokes and cardiovascular (CV) death.
Dialysis patients are at exceptional risk of accelerated vascular calcifications. Today, only parts of the blood's calcification system can be measured (e.g., calcium and phosphate). This lack of an overall picture may have resulted in suboptimal therapy guidance.
As a consequence, dialysis patients have remained at very high risk for heart attacks, peripheral artery disease, strokes and cardiovascular (CV) death.
T50 Test FOR THE MEASUREMENT OF CALCIFICATION PROPENSITY
T50 is the first and only blood test, providing a global functional assessment of your patients' humoral calcification system. T50 detects patients at risk of calcification-related CV events, guides therapies and monitors treatment success.
T50 is the first and only blood test, providing a global functional assessment of your patients' humoral calcification system. T50 detects patients at risk of calcification-related CV events, guides therapies and monitors treatment success.
View of calcification
system without T50
system without T50
View of calcification
system with T50
system with T50
What does the T50 mean?
The T50 test reports the time necessary for toxic calcified particles (CPP2) to occur in vitro. The T50 result is inversely related to the Calcification Propensity. This means a low T50 result indicates rapid occurrence of CPP2 in vitro, and thus a high Calcification Propensity.
Across studies and across CKD stages, patients with lowest T50 values (highest Calcification Propensity) were associated with worst outcome. Those CKD patients with lowest T50 values are the most vulnerable patients.
Nephrologists can use the T50 as a therapeutic aim to reduce the calcification-related cardiovascular risk. For patients having a low T50, a change in therapy achieving a moderate increase in T50 can result in a substantial reduction in their cardiovascular risk. The table below summarizes the data from 9 published clinical studies, indicating the expected risk reduction for the most important endpoints used for the management of CKD patients. The % value indicates the expected risk reduction that should follow a therapy-induced increased in T50 of 100 minutes.
Across studies and across CKD stages, patients with lowest T50 values (highest Calcification Propensity) were associated with worst outcome. Those CKD patients with lowest T50 values are the most vulnerable patients.
Nephrologists can use the T50 as a therapeutic aim to reduce the calcification-related cardiovascular risk. For patients having a low T50, a change in therapy achieving a moderate increase in T50 can result in a substantial reduction in their cardiovascular risk. The table below summarizes the data from 9 published clinical studies, indicating the expected risk reduction for the most important endpoints used for the management of CKD patients. The % value indicates the expected risk reduction that should follow a therapy-induced increased in T50 of 100 minutes.
How to use the T50?
The T50 is indicated for CKD patients 5 and 5D. T50 calcification propensity is a major modifiable cardiovascular risk factor!
Proposed algorithm for T50 in hemodialysis care:
The natural distribution of T50 values in hemodialysis population is 47 – 383 minutes.[3]
The T50 is a newly-discovered, independent, major modifiable cardiovascular risk factor (like cholesterol and high blood pressure). A therapeutic improvement of the T50 value in a patient is expected to improve prognosis. The relationship between T50 and outcome is continuous, and improvement to the T50 are expected to result in approximately proportional gains in prognosis.
T50 can be improved therapeutically, as demonstrated by increased Mg2+ in dialysate shown to increase the T50 by 50-70 minutes.[10] The treating physician can coordinate multiple therapies to maximize the therapeutic increase in T50. For example, as a rule of thumb, increasing serum Mg2+ by 0.1 mM increases T50 by ~14 min, whereas lowering serum phosphate by 0.1 mM increases T50 by ~10 minutes.
T50 lowering interventions should be avoided.
Proposed algorithm for T50 in hemodialysis care:
The natural distribution of T50 values in hemodialysis population is 47 – 383 minutes.[3]
The T50 is a newly-discovered, independent, major modifiable cardiovascular risk factor (like cholesterol and high blood pressure). A therapeutic improvement of the T50 value in a patient is expected to improve prognosis. The relationship between T50 and outcome is continuous, and improvement to the T50 are expected to result in approximately proportional gains in prognosis.
T50 can be improved therapeutically, as demonstrated by increased Mg2+ in dialysate shown to increase the T50 by 50-70 minutes.[10] The treating physician can coordinate multiple therapies to maximize the therapeutic increase in T50. For example, as a rule of thumb, increasing serum Mg2+ by 0.1 mM increases T50 by ~14 min, whereas lowering serum phosphate by 0.1 mM increases T50 by ~10 minutes.
T50 lowering interventions should be avoided.
Material and Shipment
A minimum volume of 0,5 ml of serum (not plasma) is needed. Use gel-containing tubes or separate serum from blood cells before shipment. Shipment at ambient temperature (4-37°C) is possible. Samples should reach the lab within 24 hours after blood drawing.
Where to send
Please contact Calciscon at info@calciscon.com for up-to-date list of accredited medical laboratories offering T50.
Reimbursement
Please contact Calciscon at info@calciscon.com for up-to-date information about reimbursement.
1: Bundy et al., CJASN 2019;
2: Keyzer et al., JASN 2015;
3: Pasch et al., CJASN 2016;
4: Bostom et al., AJN 2018;
5: Eelderink et al., ATVB 2020;
6: Smith et al., JASN 2014;
7: Sanchez et al., ERA-EDTA 2020;
8: Thiel et al., Clin Kidney J 2020;
9: Bressendorff et al., Kidney Int Rep 2016;
10: Bressendorff et al., CJASN 2018;
11: Shoji et al., CJASN, 2021;
12: Quinones et al., J Nephrol, 2019;
13: Ter Meulen et al., Plos One 2019;
14: Lorenz et al., NDT 2018;
15: Ponte et al., NDT 2020;
16: Dekker et al., Plos One 2016.
