Current Therapy in CKD Patients Can Affect Vitamin K Status

• Published in: Nutrients 2020-05, Vol.12 (6), p.1609
• Main Authors: Cozzolino, Mario, Cianciolo, Giuseppe, Podestà, Manuel Alfredo, Ciceri, Paola, Galassi, Andrea, Gasperoni, Lorenzo, Manna, Gaetano La
• Format: Article
• Language: English
• Subjects: Binders; Biomarkers; Bone density; Bone diseases; Bone mineral density; Bone turnover; Calcification; Calcification (ectopic); Calcium; Calcium - metabolism; Calcium phosphates; Cardiovascular diseases; Chronic illnesses; chronic kidney disease; Fibroblast growth factor 23; Fibroblast Growth Factors; Health risks; Humans; Hydroxyapatite; Hyperparathyroidism; Kidney diseases; Metabolism; Mineralization; Morbidity; Mortality; Nutrient deficiency; Osteocalcin; Parathyroid hormone; Phosphates; Phosphorylation; Phylloquinone; Proteins; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - therapy; Review; Risk analysis; Risk Factors; secondary hyperparathyroidism; vascular calcification; Vascular Calcification - metabolism; Vitamin D; Vitamin K; Vitamin K - metabolism; Vitamin K Deficiency - complications; Warfarin; Warfarin - pharmacology
• ISSN: 2072-6643; 2072-6643
• DOI: 10.3390/nu12061609

Chronic kidney disease (CKD) patients have a higher risk of cardiovascular (CVD) morbidity and mortality compared to the general population. The links between CKD and CVD are not fully elucidated but encompass both traditional and uremic-related risk factors. The term CKD-mineral and bone disorder (CKD-MBD) indicates a systemic disorder characterized by abnormal levels of calcium, phosphate, PTH and FGF-23, along with vitamin D deficiency, decreased bone mineral density or altered bone turnover and vascular calcification. A growing body of evidence shows that CKD patients can be affected by subclinical vitamin K deficiency; this has led to identifying such a condition as a potential therapeutic target given the specific role of Vitamin K in metabolism of several proteins involved in bone and vascular health. In other words, we can hypothesize that vitamin K deficiency is the common pathogenetic link between impaired bone mineralization and vascular calcification. However, some of the most common approaches to CKD, such as (1) low vitamin K intake due to nutritional restrictions, (2) warfarin treatment, (3) VDRA and calcimimetics, and (4) phosphate binders, may instead have the opposite effects on vitamin K metabolism and storage in CKD patients.