Functional vitamin K insufficiency, vascular calcification and mortality in advanced chronic kidney disease: A cohort study

• Published in: PloS one 2021-02, Vol.16 (2), p.e0247623-e0247623
• Main Authors: Dai, Lu, Li, Longkai, Erlandsson, Helen, Jaminon, Armand M G, Qureshi, Abdul Rashid, Ripsweden, Jonaz, Brismar, Torkel B, Witasp, Anna, Heimbürger, Olof, Jørgensen, Hanne Skou, Barany, Peter, Lindholm, Bengt, Evenepoel, Pieter, Schurgers, Leon J, Stenvinkel, Peter
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Albumins; Aorta; Aortic valve; Arteriosclerosis; Biochemistry; Biology and Life Sciences; Biomarkers - blood; Blood circulation disorders; C-reactive protein; Calcification; Calcification (ectopic); Calcium; Calcium phosphates; Calcium-Binding Proteins - blood; Cardiovascular disease; Cardiovascular diseases; Cholesterol; Chronic kidney failure; Cohort analysis; Cohort Studies; Complications and side effects; Computer programs; Coronary artery; Creatinine; Diabetes; Drafting software; Editing; Extracellular Matrix Proteins - blood; Female; Health aspects; Health risks; Heart valves; Hemoglobin; High density lipoprotein; Hospitals; Humans; Immunology; Intervention; Kidney diseases; Kidney transplantation; Kidneys; Laboratories; Male; Matrix Gla Protein; Medical imaging; Medicin och hälsovetenskap; Medicine; Medicine and Health Sciences; Methodology; Microbiology; Middle Aged; Monoclonal antibodies; Mortality; Nephrology; Nutrient deficiency; Patient outcomes; Patients; Phylloquinone; Physical sciences; Population studies; Proteins; Radiology; Renal Insufficiency, Chronic - blood; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - mortality; Renal Insufficiency, Chronic - pathology; Risk factors; Sensitivity; Software; Survival Rate; Technology; Transplantation; Triglycerides; Vascular Calcification - blood; Vascular Calcification - complications; Vascular Calcification - mortality; Vascular Calcification - pathology; Vitamin K; Vitamin K - blood; Vitamin K deficiency; Vitamin K Deficiency - blood; Vitamin K Deficiency - complications; Vitamin K Deficiency - mortality; Vitamin K Deficiency - pathology
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0247623

Patients with chronic kidney disease (CKD) suffer from vitamin K deficiency and are at high risk of vascular calcification (VC) and premature death. We investigated the association of functional vitamin K deficiency with all-cause mortality and whether this association is modified by the presence of VC in CKD stage 5 (CKD G5). Plasma dephosphorylated-uncarboxylated matrix Gla-protein (dp-ucMGP), a circulating marker of functional vitamin K deficiency, and other laboratory and clinical data were determined in 493 CKD G5 patients. VC was assessed in subgroups by Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC). Backward stepwise regression did not identify dp-ucMGP as an independent determinant of VC. During a median follow-up of 42 months, 93 patients died. Each one standard deviation increment in dp-ucMGP was associated with increased risk of all-cause mortality (sub-hazard ratio (sHR) 1.17; 95% confidence interval, 1.01-1.37) adjusted for age, sex, cardiovascular disease, diabetes, body mass index, inflammation, and dialysis treatment. The association remained significant when further adjusted for CAC and AVC in sub-analyses (sHR 1.22, 1.01-1.48 and 1.27, 1.01-1.60, respectively). In conclusion, functional vitamin K deficiency associates with increased mortality risk that is independent of the presence of VC in patients with CKD G5.