Calcimimetic and vitamin D analog use in hemodialyzed patients is associated with increased levels of vitamin K dependen
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ORIGINAL ARTICLE
Calcimimetic and vitamin D analog use in hemodialyzed patients is associated with increased levels of vitamin K dependent proteins Maria Fusaro1 • Sandro Giannini2 • Maurizio Gallieni3 • Marianna Noale1 • Giovanni Tripepi4 • Maurizio Rossini5 • Piergiorgio Messa6 • Paolo Rigotti7 • Tecla Pati8 • Francesco Barbisoni9 • Antonio Piccoli10 • Andrea Aghi10 • Marianna Alessi10 • Luciana Bonfante10 • Fabrizio Fabris2 • Sabina Zambon2 Stefania Sella2 • Giorgio Iervasi11 • Mario Plebani12
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Received: 9 April 2015 / Accepted: 20 June 2015 Ó Springer Science+Business Media New York 2015
Abstract Matrix Gla protein (MGP) and bone Gla protein (BGP) are two vitamin K-dependent proteins (VKDPs) involved in the regulation of vascular calcification (VC). We carried out a secondary analysis of the VIKI study to evaluate associations between drug consumption and VKDP levels in 387 hemodialyzed patients. The VIKI study assessed the prevalence of vitamin K deficiency in hemodialysis patients. We evaluated drug consumption, determined BGP and MGP levels, and verified the presence of any vertebral fractures (VF) and VC by spine radiographs. Total BGP levels were twice as high with calcimimetics versus no calcimimetics (290 vs. 158.5 mcg/L, p \ 0.0001) and 69 % higher with vitamin D analogs (268 vs. 159 mcg/L, p \ 0.0001). Total MGP was 19 % higher with calcimimetics (21.5 vs. 18.1 mcg/L, p = 0.04) and 54 % higher with calcium acetate (27.9 vs. 18.1 mcg/L,
p = 0.003); no difference was found with vitamin D analogs (21.1 vs. 18.3 mcg/L, p = 0.43). Median Total BGP level was 29 % lower in patients with C1 VF (151 vs. 213 mcg/L, p = 0.0091) and 36 % lower in patients with VC (164 vs. 262.1 mcg/L, p = 0.0003). In non-survivors, median BGP and MGP were lower, but only for MGP this difference reached the statistical significance (152 vs. 191 mcg/L, p = 0.20 and 15.0 vs. 19.7 mcg/L, p = 0.02, respectively). Pending studies on vitamin K supplementation, calcimimetics, and vitamin D analogs may play a role in preserving vitamin K-dependent protein activity, thus contributing to bone and vascular health in CKD patients.
& Maria Fusaro [email protected]
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Kidney – Pancreas Transplant Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
National Research Council (CNR), Neuroscience Institute, Via Giustiniani, 2, 35128 Padua, Italy
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Nephrology and Dialysis Unit, Hospital of Rovigo, Rovigo, Italy
Department of Medicine, Clinica Medica 1, University of Padua, Padua, Italy
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Nephrology and Dialysis Unit, Hospital of Lodi, Lodi, Italy
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Nephrology Unit, University of Padua, Padua, Italy
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CNR Institute of Clinical Physiology, Pisa, Italy
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Laboratory Medicine Unit, Department of Medicine, University of Padua, Padua, Italy
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Nephrology and Dialysis Unit, San Carlo Borromeo Hospital, Department of Biomedical and Clinical Sciences ‘‘L. Sacco’’, University of Milan, Milan, Italy
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CNR-IFC Pathophysiology of Renal Diseases and Hypertension Unit, Regg
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