The T50 is indicated for CKD patients stages 3, 4 and 5. In dialysis patients (stage CKD 5D), the T50 test is recommended to be added to the monthly electrolyte measurements.
Patients with low Calcification Propensity have the best prognosis among CKD patients. Based on the T50 result, no changes to their therapy are necessary.
Patients with high Calcification Propensity have the worst prognosis among CKD patients. The treating physician can consider changes to the therapy to aim at improving the T50 values (and hence prognosis).
Proposed algorithm for T50 in hemodialysis care:
The natural distribution of T50 values in hemodialysis population is 47 – 383 minutes.
The T50 is a newly-discovered, independent cardiovascular risk factor (like cholesterol and high blood pressure) and 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. 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 ~15 min, whereas lowering serum phosphate by 0.1 mM increases T50 by ~10 minutes.
T50 lowering interventions should be avoided.