Vitamin K, Vertebral Fractures, Vascular Calcifications, and Mortality: VItamin K Italian (VIKI) Dialysis Study

被引:119
作者
Fusaro, Maria [1 ]
Noale, Marianna [1 ]
Viola, Valentina [2 ]
Galli, Francesco [2 ]
Tripepi, Giovanni [3 ]
Vajente, Nicola [4 ]
Plebani, Mario [4 ]
Zaninotto, Martina [4 ]
Guglielmi, Giuseppe [5 ]
Miotto, Diego [6 ]
Dalle Carbonare, Luca [7 ]
D'Angelo, Angela [8 ]
Naso, Agostino [9 ]
Grimaldi, Cristina [10 ]
Miozzo, Davide [8 ]
Giannini, Sandro [11 ]
Gallieni, Maurizio [12 ]
机构
[1] Consiglio Nazl Ric CNR, Inst Neurosci, Aging Sect, Padua, Italy
[2] Univ Perugia, Sch Pharm, Dept Internal Med, Lab Biochem & Nutr, I-06100 Perugia, Italy
[3] CNR Ist Biometeorol, Reggio Di Calabria, Italy
[4] Univ Hosp Padova, Dipartimento Med Lab, Padua, Italy
[5] Univ Foggia, Dept Radiol, Foggia, Italy
[6] Univ Padua, Sez Radiol, Dipartimento Sci Med & Diagnost Terapie Speciali, Padua, Italy
[7] Univ Verona, Dept Biomed & Surg Sci, I-37100 Verona, Italy
[8] Univ Padua, Nephrol Unit, Padua, Italy
[9] Hosp Padua, Nephrol & Dialysis Unit, Padua, Italy
[10] Hosp San Giovanni Dio Florence, Nephrol & Dialysis Unit, Florence, Italy
[11] Univ Padua, Dept Clin & Expt Med, Med Clin 4, Padua, Italy
[12] Hosp San Carlo Borromeo, Nephrol & Dialysis Unit, Milan, Italy
关键词
DIALYSIS; MENAQUINONE; PHYLLOQUINONE; BONE; CALCIFICATION; MATRIX GLA-PROTEIN; CHRONIC KIDNEY-DISEASE; BONE-MINERAL DENSITY; HEMODIALYSIS-PATIENTS; HIP FRACTURE; ELDERLY-MEN; RISK; WOMEN; PROGRESSION; DEFICIENCY;
D O I
10.1002/jbmr.1677
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Vitamin K (vitamin K1 or phylloquinone and vitamin K2, a series of menaquinones [MKs]) is involved in the production of bone and matrix amino acid gamma-carboxy-glutamic acid (Gla) proteins, regulating bone and vascular calcification. Low vitamin K concentrations are associated with increased risks of fractures and vascular calcification, and frequent complications in hemodialysis patients. We carried out an observational study to establish the prevalence of vitamin K deficiency and to assess the relationship between vitamin K status, vertebral fractures, vascular calcification, and survival in 387 patients on hemodialysis for >= 1 year. We determined plasma levels of vitamin K compound, bone-Gla-protein, matrix-Gla-protein, and routine biochemistry. Vertebral fractures (reduction in vertebral body height by >= 20%) and aortic and iliac calcifications were also investigated in a spine (D-5-L-4) radiograph. Three-year patient survival was analyzed. Important proportions of patients had deficiency of MK7 (35.4%), vitamin K1 (23.5%), and MK4 (14.5%). A total of 55.3% of patients had vertebral fractures, 80.6% had abdominal aorta calcification, and 56.1% had iliac calcification. Vitamin K1 deficiency was the strongest predictor of vertebral fractures (odds ratio [OR], 2.94; 95% confidence interval [CI], 1.38-6.26). MK4 deficiency was a predictor of aortic calcification (OR, 2.82; 95% CI, 1.14-7.01), whereas MK5 deficiency actually protected against it (OR, 0.38; 95% CI, 0.15-0.95). MK7 deficiency was a predictor of iliac calcification (OR, 1.64; 95% CI, 1.03-2.60). The presence of vertebral fractures was also a predictor of vascular calcifications (OR, 1.76; 95% CI, 1.00-3.08). Increased alkaline phosphatase and C reactive protein (CRP), age, and cerebrovascular events were predictors of mortality. Our study suggests that the vitamin K system may be important for preserving bone mass and avoiding vascular calcification in hemodialysis patients, pointing out a possible role of vitamin K in bone and vascular health. Based on our results, we suggest that the general population should also be studied for vitamin K deficiency as a possible cause of both vertebral fractures and vascular calcification. (C) 2012 American Society for Bone and Mineral Research.
引用
收藏
页码:2271 / 2278
页数:8
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