{"doi":"10.1016/j.ekir.2020.06.022","title":"Serum Calcification Propensity in Children on Chronic Hemodialysis","abstract":"Disturbances in mineral metabolism, including elevations in parathyroid hormone (PTH), phosphate, and calcium × phosphate product, occur in patients with end-stage kidney disease (ESKD) and likely play an important role in cardiovascular morbidity and mortality.1Block G.A. Kilpatrick R.D. Lowe K.A. et al.CKD-mineral and bone disorder and risk of death and cardiovascular hospitalization in patients on hemodialysis.Clin J Am Soc Nephrol. 2013; 8: 2132-2140Crossref PubMed Scopus (70) Google Scholar In patients with chronic kidney disease (CKD), serum calcium and phosphate can precipitate in the vascular smooth muscle cell of the arteries, causing vascular calcification and vessel stiffening.S1 Serum calcification is a tightly regulated process inhibited by small molecules (such as magnesium, bicarbonate, and pyrophosphate) and acidic plasma proteins (including albumin and fetuin-A).2Pasch A. Block G.A. Bachtler M. et al.Blood calcification propensity, cardiovascular events, and survival in patients receiving hemodialysis in the EVOLVE trial.Clin J Am Soc Nephrol. 2017; 12: 315-322Crossref PubMed Scopus (64) Google Scholar, 3Pasch A. Farese S. Graber S. et al.Nanoparticle-based test measures overall propensity for calcification in serum.J Am Soc Nephrol. 2012; 23: 1744-1752Crossref PubMed Scopus (171) Google Scholar, 4Heiss A. Eckert T. Aretz A. et al.Hierarchical role of fetuin-A and acidic serum proteins in the formation and stabilization of calcium phosphate particles.J Biol Chem. 2008; 283: 14815-14825Crossref PubMed Scopus (155) Google Scholar Dystrophic calcification of soft tissues and vascular walls can occur when these homeostatic defenses are overwhelmed. Pasch et al. developed a functional nanoparticle based in vitro test (T50 test) that time-dependently assesses the ex vivo calcification propensity of serum. In the presence of serum proteins, supersaturated calcium and phosphate solutions form amorphous primary calciprotein particles (CPPs). These undergo a transition in shape and size into crystalline secondary CPPs (which induce vascular smooth muscle cell calcification) in a timed and coordinated manner. The T50 test detects the changes in laser light scattering (nephelometry) to determine the one-half maximal conversion time of primary to secondary CPPs.3Pasch A. Farese S. Graber S. et al.Nanoparticle-based test measures overall propensity for calcification in serum.J Am Soc Nephrol. 2012; 23: 1744-1752Crossref PubMed Scopus (171) Google Scholar In adults, lower T50 has been shown to predict cardiovascular and all-cause mortality in advanced CKD, hemodialysis (HD), and kidney transplant populations,2Pasch A. Block G.A. Bachtler M. et al.Blood calcification propensity, cardiovascular events, and survival in patients receiving hemodialysis in the EVOLVE trial.Clin J Am Soc Nephrol. 2017; 12: 315-322Crossref PubMed Scopus (64) Google Scholar,5Smith E.R. Ford M.L. Tomlinson L.A. et al.Serum calcification propensity predicts all-cause mortality in predialysis CKD.J Am Soc Nephrol. 2014; 25: 339-348Crossref PubMed Scopus (122) Google Scholar,S2,S3 with changes in serum phosphate levels demonstrating the strongest independent association with decline in T50.6Lorenz G. Steubl D. Kemmner S. et al.Worsening calcification propensity precedes all-cause and cardiovascular mortality in haemodialyzed patients.Sci Rep. 2017; 7: 13368Crossref PubMed Scopus (19) Google Scholar In adults with CKD, higher serum calcification propensity was associated with severity and progression of coronary artery calcification.S4 Age-specific mortality is 30- to 150-fold higher in children with ESKD than in the general pediatric population,S5–S7 and cardiovascular mortality is 1000-fold higher.S8 Coronary calcification is highly prevalent among young adult HD patientsS9,S10 and present even in children and adolescents with ESKD.7Civilibal M. Caliskan S. Adaletli I. et al.Coronary artery calcifications in children with end-stage renal disease.Pediatr","journal":"Kidney International Reports","year":2020,"id":107368,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9707,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":516321,"name":"Andreas Pasch","orcid":"0000-0002-7439-0748","position":1,"is_corresponding":false},{"id":516322,"name":"Rachel Rogers","orcid":"0000-0002-1611-0373","position":2,"is_corresponding":false},{"id":788,"name":"Andrew N. Hoofnagle","orcid":"0000-0002-6449-0243","position":3,"is_corresponding":false},{"id":517024,"name":"Sherin Meloni","orcid":null,"position":4,"is_corresponding":false},{"id":261904,"name":"Susan L. Furth","orcid":"0000-0003-2081-5242","position":5,"is_corresponding":false},{"id":417333,"name":"Mary B. Leonard","orcid":"0000-0002-8972-6582","position":6,"is_corresponding":false},{"id":516323,"name":"Lawrence Copelovitch","orcid":"0000-0002-7748-3560","position":7,"is_corresponding":false},{"id":312222,"name":"Michelle Denburg","orcid":"0000-0002-0704-3607","position":8,"is_corresponding":false},{"id":516320,"name":"Aadil Kakajiwala","orcid":"0000-0002-4172-916X","position":0,"is_corresponding":true}],"reference_count":10,"raw_metadata":null,"created_at":"2026-07-18T23:12:34.898963Z","pmid":"32954079","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}