Cinacalcet, dialysate calcium concentration, and cardiovascular events in the EVOLVE trial.

Journal Article (Journal Article)

Among patients receiving hemodialysis, abnormalities in calcium regulation have been linked to an increased risk of cardiovascular events. Cinacalcet lowers serum calcium concentrations through its effect on parathyroid hormone secretion and has been hypothesized to reduce the risk of cardiovascular events. In observational cohort studies, prescriptions of low dialysate calcium concentration and larger observed serum-dialysate calcium gradients have been associated with higher risks of in-dialysis facility or peri-dialytic sudden cardiac arrest. We performed this study to examine the risks associated with dialysate calcium and serum-dialysate gradients among participants in the Evaluation of Cinacalcet Hydrochloride Therapy to Lower Cardiovascular Events (EVOLVE) trial. In EVOLVE, 3883 hemodialysis patients were randomized 1:1 to cinacalcet or placebo. Dialysate calcium was administered at the discretion of treating physicians. We examined whether baseline dialysate calcium concentration or the serum-dialysate calcium gradient modified the effect of cinacalcet on the following adjudicated endpoints: (1) primary composite endpoint (death or first non-fatal myocardial infarction, hospitalization for unstable angina, heart failure, or peripheral vascular event); (2) cardiovascular death; and (3) sudden death. In EVOLVE, use of higher dialysate calcium concentrations was more prevalent in Europe and Latin America compared with North America. There was a significant fall in serum calcium concentration in the cinacalcet group; dialysate calcium concentrations were changed infrequently in both groups. There was no association between baseline dialysate calcium concentration or serum-dialysate calcium gradient and the endpoints examined. Neither the baseline dialysate calcium nor the serum-dialysate calcium gradient significantly modified the effects of cinacalcet on the outcomes examined. The effects of cinacalcet on cardiovascular death and major cardiovascular events are not altered by the dialysate calcium prescription and serum-dialysate calcium gradient.

Full Text

Duke Authors

Cited Authors

  • Pun, PH; Abdalla, S; Block, GA; Chertow, GM; Correa-Rotter, R; Dehmel, B; Drüeke, TB; Floege, J; Goodman, WG; Herzog, CA; London, GM; Mahaffey, KW; Moe, SM; Parfrey, PS; Wheeler, DC; Middleton, JP

Published Date

  • July 2016

Published In

Volume / Issue

  • 20 / 3

Start / End Page

  • 421 - 431

PubMed ID

  • 26564024

Pubmed Central ID

  • PMC4866914

Electronic International Standard Serial Number (EISSN)

  • 1542-4758

Digital Object Identifier (DOI)

  • 10.1111/hdi.12382


  • eng

Conference Location

  • Canada