Maria Fusaro1, Claudia D'Alessandro2, Marianna Noale3, Giovanni Tripepi4, Mario Plebani5, Nicola Veronese6, Giorgio Iervasi7, Sandro Giannini8, Maurizio Rossini9, Giovanni Tarroni10, Sandro Lucatello11, Alberto Vianello12, Irene Santinello13, Luciana Bonfante14, Fabrizio Fabris8, Stefania Sella8, Antonio Piccoli13, Agostino Naso13, Daniele Ciurlino14, Andrea Aghi8, Maurizio Gallieni15, Adamasco Cupisti2. 1. National Research Council (CNR) - Institute of Clinical Physiology (IFC), Pisa, Italy; Department of Medicine, University of Padua, Italy. Electronic address: dante.lucia@libero.it. 2. Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy. 3. National Research Council (CNR), Neuroscience Institute, Padua, Italy. 4. Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Calabria, Italy. 5. Laboratory Medicine Unit, Department of Medicine, University of Padua, Italy. 6. Department of Medicine (DI-MED), Geriatric Section, University of Padua, Italy. 7. National Research Council (CNR) - Institute of Clinical Physiology (IFC), Pisa, Italy; Department of Medicine, University of Padua, Italy. 8. Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy. 9. Rheumatology Unit, Department of Medicine, University of Verona, Italy. 10. Nephrology Unit, ULSS 1 Belluno, Italy. 11. UOC Nephrology and Dialysis, ULSS 13, Dolo, Italy. 12. UOC Nephrology and Dialysis, ULSS 2, Feltre, Italy. 13. Nephrology Unit, University of Padua, Padua, Italy. 14. Renal Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy. 15. Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy; Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Italy.
Abstract
BACKGROUND & AIMS: Vitamin K acts as a coenzyme in the γ-carboxylation of vitamin K-dependent proteins, including coagulation factors, osteocalcin, matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6) protein. Osteocalcin is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification. GAS6 activity prevents the apoptosis of vascular smooth muscle cells. Few data on vitamin K intake in chronic kidney disease patients and no data in patients on a Mediterranean diet are available. In the present study, we evaluate the dietary intake of vitamin K1 in a cohort of patients undergoing haemodialysis. METHODS: In this multi-centre controlled observational study, data were collected from 91 patients aged >18 years on dialysis treatment for at least 12 months and from 85 age-matched control subjects with normal renal function. Participants completed a food journal of seven consecutive days for the estimation of dietary intakes of macro- and micro-nutrients (minerals and vitamins). RESULTS: Compared to controls, dialysis patients had a significant lower total energy intake, along with a lower dietary intake of proteins, fats, carbohydrates, fibres, and of all the examined minerals (Ca, P, Fe, Na, K, Zn, Cu, and Mg). With the exception of vitamin B12, vitamins intake followed a similar pattern, with a lower intake in vitamin A, B1, B2, C, D, E, folates, K1 and PP. These finding were confirmed also when normalized for total energy intake or for body weight. In respect to the adequate intakes recommended in the literature, the prevalence of a deficient vitamin K intake was very high (70-90%) and roughly double than in controls. Multivariate logistic model identified vitamin A and iron intake as predictors of vitamin K deficiency. CONCLUSIONS: Haemodialysis patients had a significantly low intake in vitamin K1, which could contribute to increase the risk of bone fractures and vascular calcifications. Since the deficiency of vitamin K intake seems to be remarkable, dietary counselling to HD patients should also address the adequacy of vitamin K dietary intake and bioavailability. Whether diets with higher amounts of vitamin K1 or vitamin K supplementation can improve clinical outcomes in dialysis patients remains to be demonstrated.
BACKGROUND & AIMS:Vitamin K acts as a coenzyme in the γ-carboxylation of vitamin K-dependent proteins, including coagulation factors, osteocalcin, matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6) protein. Osteocalcin is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification. GAS6 activity prevents the apoptosis of vascular smooth muscle cells. Few data on vitamin K intake in chronic kidney diseasepatients and no data in patients on a Mediterranean diet are available. In the present study, we evaluate the dietary intake of vitamin K1 in a cohort of patients undergoing haemodialysis. METHODS: In this multi-centre controlled observational study, data were collected from 91 patients aged >18 years on dialysis treatment for at least 12 months and from 85 age-matched control subjects with normal renal function. Participants completed a food journal of seven consecutive days for the estimation of dietary intakes of macro- and micro-nutrients (minerals and vitamins). RESULTS: Compared to controls, dialysis patients had a significant lower total energy intake, along with a lower dietary intake of proteins, fats, carbohydrates, fibres, and of all the examined minerals (Ca, P, Fe, Na, K, Zn, Cu, and Mg). With the exception of vitamin B12, vitamins intake followed a similar pattern, with a lower intake in vitamin A, B1, B2, C, D, E, folates, K1 and PP. These finding were confirmed also when normalized for total energy intake or for body weight. In respect to the adequate intakes recommended in the literature, the prevalence of a deficient vitamin K intake was very high (70-90%) and roughly double than in controls. Multivariate logistic model identified vitamin A and iron intake as predictors of vitamin K deficiency. CONCLUSIONS: Haemodialysis patients had a significantly low intake in vitamin K1, which could contribute to increase the risk of bone fractures and vascular calcifications. Since the deficiency of vitamin K intake seems to be remarkable, dietary counselling to HDpatients should also address the adequacy of vitamin K dietary intake and bioavailability. Whether diets with higher amounts of vitamin K1 or vitamin K supplementation can improve clinical outcomes in dialysis patients remains to be demonstrated.
Authors: Sagar U Nigwekar; Donald B Bloch; Rosalynn M Nazarian; Cees Vermeer; Sarah L Booth; Dihua Xu; Ravi I Thadhani; Rajeev Malhotra Journal: J Am Soc Nephrol Date: 2017-01-03 Impact factor: 10.121
Authors: Ineke J Riphagen; Charlotte A Keyzer; Nadja E A Drummen; Martin H de Borst; Joline W J Beulens; Ron T Gansevoort; Johanna M Geleijnse; Frits A J Muskiet; Gerjan Navis; Sipke T Visser; Cees Vermeer; Ido P Kema; Stephan J L Bakker Journal: Nutrients Date: 2017-12-08 Impact factor: 5.717