Figure 22. Effect of cinacalcet on cardiovascular outcomes of patients on hemodialysis therapy. The randomized controlled trial EVOLVE examined the question whether a better control of secondary uremic hyperparathyroidism by cinacalcet, as compared to placebo treatment with standard of care, reduced the incidence of cardiovascular events and mortality. The study enrolled 3803 patients receiving long-term hemodialysis therapy. Using intention-to-treat analysis the study outcome was negative (upper part of Figure). However, with lag-censoring analysis there was a nominally significant reduction in the primary composite cardiovascular endpoint in the cinacalcet treatment group in whom serum PTH, calcium, and phosphorus were better controlled than in the placebo treatment group (lower part of Figure). From Chertow et al (298).