Sevelamer Use, Vitamin K Levels, Vascular Calcifications, and Vertebral Fractures in Hemodialysis Patients: Results from the VIKI Study.

Autor: Fusaro M; National Research Council (CNR)-Institute of Clinical Physiology (IFC), Pisa, Italy.; Department of Medicine, University of Padua, Padua, Italy., Cozzolino M; Renal Division, Department of Health Sciences, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy., Plebani M; Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy., Iervasi G; National Research Council (CNR)-Institute of Clinical Physiology (IFC), Pisa, Italy., Ketteler M; Department of General Internal Medicine and Nephrology, Robert-Bosch-Krankenhaus, Stuttgart, Germany., Gallieni M; Nephrology and Dialysis Unit, Azienda Socio-Sanitaria Territoriale (ASST) Fatebenefratelli Sacco, Department of Clinical and Biomedical Sciences 'Luigi Sacco', Università di Milano, Milan, Italy., Aghi A; Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy., Locatelli F; Alessandro Manzoni Hospital, ASST Lecco, Lecco, Italy., Cunningham J; The Royal Free Hospital and UCL Medical School, London, UK., Salam S; Sheffield Kidney Institute, Sheffield Teaching Hospitals National Health Service Foundation Trust, and Academic Unit of Bone Metabolism and Mellanby Centre for Bone Research, Medical School-University of Sheffield, Sheffield, UK., Zaninotto M; Department of Medicine, University of Padua, Padua, Italy., Ravera M; Clinica Nefrologica, Dialisi e Trapianto, Universita' di Genova e Policlinico San Martino, Genoa, Italy., Russo D; Department of Public Health, University of Naples Federico II, Naples, Italy., Mereu MC; Independent Researcher, Cagliari, Italy., Giannini S; Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy., Brandi ML; Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy., Ferrari S; Service des Maladies Osseuses, Département de Médecine, HUG, Genève, Switzerland., Sella S; Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy., Egan CG; CE-Medical Writing, Pisa, Italy., Bellasi A; UOC Ricerca, Innovazione, Brand Reputation, ASST-Papa Giovanni XXIII, Bergamo, Italy., Di Lullo L; Department of Nephrology and Dialysis, L. Parodi, Delfino Hospital, Rome, Italy., Tripepi G; CNR-IFC, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Calabria, Italy., Nickolas T; Division of Nephrology, Department of Medicine, Columbia University Irving Medical Center, New York City, NY, USA.
Jazyk: angličtina
Zdroj: Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research [J Bone Miner Res] 2021 Mar; Vol. 36 (3), pp. 500-509. Date of Electronic Publication: 2020 Dec 03.
DOI: 10.1002/jbmr.4214
Abstrakt: Hyperphosphatemia is a risk factor for vascular calcifications (VCs), which are part of the chronic kidney disease-mineral and bone disorders (CKD-MBD). Vitamin K-dependent proteins such as matrix Gla protein (MGP) and bone Gla proteins (BGP, or osteocalcin) can inhibit VCs and regulate bone mineralization. In this analysis of the Vitamin K Italian (VIKI) study, the relationship between vitamin K status, vertebral fractures (VFs) and VCs in 387 hemodialysis (HD) patients with (N = 163; 42.1%) or without N = 224; 57.9%) sevelamer was evaluated. Levels of vitamin K vitamers K1 and K2 or menaquinones (MK; MK4-7), total and undercarboxylated (uc) forms for both BGP and MGP were determined. Although no differences in clinical characteristics were noted, lower levels of MK4 (0.45 versus 0.6 ng/mL, p = .01) and a greater MK4 deficiency was observed in sevelamer-treated patients (13.5% versus 5.4%, p = .005). Multivariate logistic regression revealed that MK4 deficiency was associated with sevelamer use (odds ratio [OR] = 2.64, 95% confidence interval [CI] 1.25-5.58, p = .011) and aortic calcification (OR = 8.04, 95% CI 1.07-60.26, p = .04). In the same logistic model, sevelamer amplified the effect of total BGP levels on the odds of VFs in patients with total BGP <150 μg/L compared with those with total BGP ≥150 μg/L (OR = 3.15, 95% CI 1.46-6.76, p = .003). In contrast, there was no such effect in those untreated (total BGP <150 μg/L versus total BGP ≥150 μg/L: OR = 1.21, 95% CI 0.66-2.23, p = .54]; p = .049 for effect modification by sevelamer). Sevelamer may interfere with MK4 levels in HD patients and interact with low BGP levels to increase bone fractures in CKD patients. © 2020 American Society for Bone and Mineral Research (ASBMR).
(© 2020 American Society for Bone and Mineral Research (ASBMR).)
Databáze: MEDLINE
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