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Rigshospitalet - en del af Københavns Universitetshospital
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Vitamin K supplementation and arterial calcification in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial

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  • Karin Levy-Schousboe
  • Marie Frimodt-Møller
  • Ditte Hansen
  • Christian Daugaard Peters
  • Krista Dybtved Kjærgaard
  • Jens Dam Jensen
  • Charlotte Strandhave
  • Hanne Elming
  • Carsten Toftager Larsen
  • Hanne Sandstrøm
  • Claus Lohman Brasen
  • Anne Schmedes
  • Jonna Skov Madsen
  • Niklas Rye Jørgensen
  • Jens Brøndum Frøkjær
  • Niels Erik Frandsen
  • Inge Petersen
  • Peter Marckmann
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Background: Arterial calcification is associated with cardiovascular mortality in dialysis patients. Active matrix Gla protein (MGP) is a vitamin K-dependent inhibitor of arterial calcification. Elevated plasma concentrations of inactive MGP, i.e. dephosphorylated-uncarboxylated MGP (dp-ucMGP), are prevalent in dialysis patients. MGP inactivity might contribute to arterial calcification. We investigated whether vitamin K supplementation had an effect on arterial calcification in chronic dialysis patients.

Methods: In a 2-year, double-blind, placebo-controlled intervention trial, 48 dialysis patients were randomized to vitamin K [menaquinone-7 (MK-7), 360 µg daily] or placebo. MK-7 in serum and dp-ucMGP in plasma were used to assess vitamin K status. Carotid-femoral pulse wave velocity (cfPWV) and scores of coronary arterial calcification (CAC) and abdominal aortic calcification (AAC) were used to assess arterial calcification.

Results: Thirty-seven participants completed Year 1, and 21 completed Year 2. At Year 2, serum MK-7 was 40-fold higher, and plasma dp-ucMGP 40% lower after vitamin K supplementation compared with placebo {mean dp-ucMGP difference: -1380 pmol/L [95% confidence interval (CI) -2029 to -730]}. There was no significant effect of vitamin K supplementation on cfPWV [mean difference at Year 2: 1.2 m/s (95% CI -0.1 to 2.4)]. CAC Agatston score increased significantly in vitamin K supplemented participants, but was not significantly different from placebo [mean difference at Year 2: 664 (95% CI -554 to 1881)]. AAC scores increased in both groups, significantly so within the placebo group at Year 1, but with no significant between-group differences.

Conclusions: Vitamin K supplementation improved vitamin K status, but did not hinder or modify the progression of arterial calcification in dialysis patients.

OriginalsprogEngelsk
TidsskriftClinical kidney journal
Vol/bind14
Udgave nummer9
Sider (fra-til)2114-2123
Antal sider10
ISSN2048-8505
DOI
StatusUdgivet - sep. 2021

ID: 67500744