Phosphate binders affect vitamin K concentration by undesired binding, an in vitro study

Background: Vascular calcification is a major contributing factor to mortality in end stage renal disease (ESRD). Despite the efficacy of phosphate binders to improve hyperphosphatemia, data on vascular calcification are less clear. There seems to be a difference in attenuation or delay in progression between different binders. In this in vitro experiment we tested whether phosphate binders could limit bioavailability of vitamin K2 by undesired binding. Vitamin K-deficiency limits activation of the vascular tissue mineralization inhibitor matrix nu-carboxyglutamate (Gla) protein (MGP) thereby exacerbating vascular calcification. Methods: In this experiment vitamin K2 (menaquinone-7; MK-7) binding was assessed by adding 1 mg of vitamin K2 to a medium with pH 6 containing 67 mg phosphate binder with either 7 mg of phosphate or no phosphate. Five different phosphate binders were tested. After five and a half hours vitamin K was analyzed by HPLC. All experiments were performed in triplicate. Results: Sucroferric-oxyhydroxide and sevelamer carbonate did not significantly bind vitamin K2, both in solution only containing vitamin K2 or in combination with phosphate. Calcium acetate/magnesium carbonate binds vitamin K2 strongly both in absence (rho = 0.001) and presence of phosphate (rho = 0.003). Lanthanum carbonate significantly binds vitamin K2 in solution containing only vitamin K2 (rho = 0.005) whereas no significant binding of vitamin K2 was observed in the solution containing vitamin K2 and phosphate (rho = 0.462). Calcium carbonate binds vitamin K2 significantly in a solution with vitamin K2 and phosphate (rho = 0.009) whereas without phosphate no significant binding of vitamin K2 was observed (rho = 0.123). Conclusions: Sucroferric-oxyhydroxide and sevelamer carbonate were the only binders of the five binders studied that did not bind vitamin K2 in vitro. The presence or absence of phosphate significantly interferes with vitamin K2 binding so phosphate binders could potentially limit bioavailability vitamin K2.