scholarly journals P1485SEVELAMER USE IS ASSOCIATED WITH DECREASED VITAMIN K LEVELS IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Maria Fusaro ◽  
Andrea Aghi ◽  
Pascale Khairallah ◽  
Maurizio Gallieni ◽  
Mario Gennaro Cozzolino ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Matrix Gla Protein ◽  
Phosphate Binding ◽  
Cross Sectional ◽  
K Deficiency ◽  
Causal Nature ◽  
The Relationship

Abstract Background and Aims Sevelamer (S) is a phosphate binding drug used to treat hyperphosphatemia in patients with CKD. Our aim was to evaluate the hypothesis that the use of (S) could interfere with Vitamin K absorption in hemodialysis (HD) patients of VIKI study. Method We tested this hypothesis in VIKI, a cross-sectional study of 387 hemodialysis patients, we established the prevalence of vitamin K deficiency and to assessed the relationship between vitamin K status, vertebral fractures, vascular calcification. We determined serum concentrations of vitamin 25(OH)D; alkaline phosphatase (ALP); vitamers K1, MK4, MK5, MK6, MK7; osteocalcin (BGP) and Matrix Gla Protein (MGP). We highlighted that MK4 deficiency was the strongest predictor of aortic calcification (OR, 2.82; 95% CI, 1.14–7.01) while vitamin K1 deficiency was the strongest predictor of vertebral fractures fractures (OR: 2.94; 95% CI, 1.38–6.26). Results 163 of 387 patients (42.1%) were treated with Sevelamer. There were no differences in levels of 25(OH)D, K1, MK5, MK6 and MK7 among patients treated with and without Sevelamer. Remarkably, the prevalence of MK4 deficiency was higher in Sevelamer treated patients (13.5% vs 5.4%, p=0.005). Sevelamer treated patients also had higher median levels of ALK (89 UI/L vs 77.5 UI/L, p=0.001) and total BGP (210 mcg/L vs 152 mcg/L, p=0.002) and lower median levels of total MGP (16.4 nmol/L vs 20.3 nmol/L, p=0.037) (Table 1 and Figure 1). In multivariable logistic regression, the odds ratio of MK4 deficiency (dependent variable) in patients treated with compared to without Sevelamer was ∼3-fold higher (OR: 2.64, 95% CI: 1.25-5.58, p=0.011) after adjustment for confounders of Vitamin K levels, including older age, previous myocardial infarction, type of HD, ALP, PTH, MGP, BGP, cholesterol and albumin. Conclusion These data support the hypothesis that Sevelamer could interfere with MK4 absorption in HD patients. Longitudinal interventional studies are needed to prove the causal nature of these associations.

Lower diastolic blood pressure in healthy subjects with vitamin K deficiency: a preliminary cross-sectional study

10.20883/181 ◽  
2016 ◽  
Vol 85 (4) ◽  
pp. 276
Author(s):  
Jan Krzysztof Nowak ◽  
Andrzej Wykrętowicz ◽  
Patrycja Krzyżanowska ◽  
Agnieszka Górna ◽  
Jarosław Tobolski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Vitamin K ◽  
Healthy Subjects ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Vitamin K Deficiency ◽  
Cross Sectional ◽  
K Deficiency ◽  
The Relationship

Introduction. There is a growing body of evidence for the role of vitamin K in cardiovascular health. As a cofactor of carboxylation of the matrix Gla protein it prevents arterial calcification. However, the data on the relationship between vitamin K status and the blood pressure are scarce, and particularly so in persons without the burden of cardiovascular risk factors. Material and Methods. We performed a pilot cross‑sectional study, in which we hypothesized that vitamin K deficiency is associated with a higher blood pressure in young, healthy people. The concentration of protein induced by vitamin K absence‑II (PIVKA‑II) larger than 2 ng/mL was chosen as a proxy for vitamin K deficiency; it was assessed in serum using ELISA. Blood pressure was measured using a validated, automated oscillometric monitor in triplicate.Results. Twenty‑three healthy subjects were enrolled (16 female; mean age 21.3 ± 1.6 years; body mass index 20.6 ± 2.4 kg/m2). The diastolic blood pressure (DBP) was lower in vitamin K‑deficient subjects (58 ± 9 vs. 67 ± 5 mmHg, p = 0.01). The mean arterial blood pressure also differed (75 ± 9 vs. 83 ± 6, p = 0.02). PIVKA‑II levels correlated with DBP only (Pearson’s R = -0.41, p < 0.05; Spearman’s ρ ns.). Stepwise regression identified PIVKA‑II concentrations as the only independent parameter associated with DBP (adjusted R2 = 13.1%; PIVKA‑II: β = -0.41; 95%CI -1.87-(-0.00098), t = -2.08, p < 0.05).Conclusions. The relationship between vitamin K deficiency and low DBP in young adults should be investigated further.

Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross‐Sectional Study

2021 ◽  
Author(s):  
Maria Fusaro ◽  
Giuseppe Cianciolo ◽  
Giovanni Tripepi ◽  
Mario Plebani ◽  
Andrea Aghi ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Lower diastolic blood pressure in healthy subjects with vitamin K deficiency: a preliminary cross-sectional study

2016 ◽  
Vol 85 (4) ◽  
pp. 276-280
Author(s):  
Jan Krzysztof Nowak ◽  
Andrzej Wykrętowicz ◽  
Patrycja Krzyżanowska ◽  
Agnieszka Górna ◽  
Jarosław Tobolski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Diastolic Blood Pressure ◽  
Vitamin K ◽  
Healthy Subjects ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Vitamin K Deficiency ◽  
Cross Sectional ◽  
K Deficiency ◽  
The Relationship

Introduction. There is a growing body of evidence for the role of vitamin K in cardiovascular health. As a cofactor of carboxylation of the matrix Gla protein it prevents arterial calcification. However, the data on the relationship between vitamin K status and the blood pressure are scarce, and particularly so in persons without the burden of cardiovascular risk factors. Material and Methods. We performed a pilot cross-sectional study, in which we hypothesized that vitamin K deficiency is associated with a higher blood pressure in young, healthy people. The concentration of protein induced by vitamin K absence-II (PIVKA-II) larger than 2 ng/mL was chosen as a proxy for vitamin K deficiency; it was assessed in serum using ELISA. Blood pressure was measured using a validated, automated oscillometric monitor in triplicate.Results. Twenty-three healthy subjects were enrolled (16 female; mean age 21.3 ± 1.6 years; body mass index 20.6 ± 2.4 kg/m2). The diastolic blood pressure (DBP) was lower in vitamin K-deficient subjects (58 ± 9 vs. 67 ± 5 mmHg, p = 0.01). The mean arterial blood pressure also differed (75 ± 9 vs. 83 ± 6, p = 0.02). PIVKA-II levels correlated with DBP only (Pearson’s R = -0.41, p < 0.05; Spearman’s ? ns.). Stepwise regression identified PIVKA-II concentrations as the only independent parameter associated with DBP (adjusted R2 = 13.1%; PIVKA-II: ß = -0.41; 95%CI -1.87-(-0.00098), t = -2.08, p < 0.05).Conclusions. The relationship between vitamin K deficiency and low DBP in young adults should be investigated further.

scholarly journals The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study

Nutrients ◽  
2021 ◽  
Vol 13 (10) ◽  
pp. 3567
Author(s):  
Maria Fusaro ◽  
Giovanni Tripepi ◽  
Mario Plebani ◽  
Cristina Politi ◽  
Andrea Aghi ◽  
...  
Keyword(s):  
Vitamin K ◽  
Vertebral Fractures ◽  
Body Height ◽  
Fragility Fractures ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
High Morbidity ◽  
Cross Sectional ◽  
Relevant Risk Factor ◽  
Stage Renal Disease

Vascular calcification and fragility fractures are associated with high morbidity and mortality, especially in end-stage renal disease. We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aortic calcifications (AACs) with the risk for vertebral fractures (VFs) in hemodialysis patients. The VIKI study was a multicenter cross-sectional study involving 387 hemodialysis patients. The biochemical data included bone health markers, such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate. VF, IACs and AACs was determined through standardized spine radiograms. VF was defined as >20% reduction of vertebral body height, and VC were quantified by measuring the length of calcium deposits along the arteries. The prevalence of IACs and AACs were 56.1% and 80.6%, respectively. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p = 0.028), whereas we found no association (p = 0.294) for AACs. IACs were associated with VF irrespective of calcification severity. Patients with IACs had lower levels of vitamin K2 and menaquinone 7 (0.99 vs. 1.15 ng/mL; p = 0.003), and this deficiency became greater with adjustment for triglycerides (0.57 vs. 0.87 ng/mL; p < 0.001). IACs, regardless of their extent, are a clinically relevant risk factor for VFs. The association is enhanced by adjusting for vitamin K, a main player in bone and vascular health. To our knowledge these results are the first in the literature. Prospective studies are needed to confirm these findings both in chronic kidney disease and in the general population.

scholarly journals Vitamin K Status in Adherent and Non-Adherent Patients with Phenylketonuria: A Cross-Sectional Study

Nutrients ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 1772
Author(s):  
Renata Mozrzymas ◽  
Dariusz Walkowiak ◽  
Sławomira Drzymała-Czyż ◽  
Patrycja Krzyżanowska-Jankowska ◽  
Monika Duś-Żuchowska ◽  
...  
Keyword(s):  
Vitamin K ◽  
Cross Sectional Study ◽  
Dietary Vitamin ◽  
Dietary Recommendations ◽  
Vitamin K Deficiency ◽  
Cross Sectional ◽  
Dietary Compliance ◽  
Dietary Consumption ◽  
Vitamin Intake ◽  
K Deficiency

This is the first study to evaluate vitamin K status in relation to dietary intake and phenylalanine dietary compliance in patients with phenylketonuria (PKU). The dietary and PKU formula intake of vitamin K was calculated in 34 PKU patients, with vitamin K status determined by the measurement of prothrombin induced by vitamin K absence (PIVKA-II). Blood phenylalanine concentrations in the preceding 12 months were considered. There were significantly more phenylalanine results exceeding 6 mg/dL in patients with normal PIVKA-II concentrations than in those with abnormal PIVKA-II levels (p = 0.035). Similarly, a higher total intake of vitamin K and dietary vitamin intake expressed as μg/day (p = 0.033 for both) and %RDA (p = 0.0002 and p = 0.003, respectively) was observed in patients with normal PIVKA-II levels. Abnormal PIVKA-II concentrations were associated with a lower OR (0.1607; 95%CI: 0.0273–0.9445, p = 0.043) of having a median phenylalanine concentration higher than 6 mg/dL. In conclusion, vitamin K deficiency is not uncommon in phenylketonuria and may also occur in patients with adequate vitamin K intake. PKU patients with better dietary compliance have a higher risk of vitamin K deficiency. The present findings highlight the need for further studies to re-evaluate dietary recommendations regarding vitamin K intake, both concerning formula-based and dietary consumption of natural products.

MO798ORAL CALCITRIOL USE, VERTEBRAL FRACTURES AND VASCULAR CALCIFICATION IN HEMODIALYSIS PATIENTS: RESULTS FROM VITAMIN K ITALIAN (VIKI) STUDY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Maria Fusaro ◽  
Andrea Aghi ◽  
Cristina Politi ◽  
Thomas Nickolas ◽  
Giuseppe Cianciolo ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Vertebral Fractures ◽  
Body Height ◽  
Secondary Analysis ◽  
Fragility Fractures ◽  
Matrix Gla Protein ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Calcific Deposits

Abstract Background and Aims In patients with Chronic Kidney Disease (CKD) mineral, bone, and calcific cardiovascular abnormalities are associated to adverse clinical outcomes, including fractures, cardiovascular events and mortality. Vitamin D hormonal system along with alteration levels that occur in calcium, phosphate, PTH, FGF23/Klotho are the main responsible of the bone and vascular metabolism changes, particularly in hemodialysis (HD) patients that experienced the very negative clinical consequences (decreased bone mass, increased fragility fractures and vascular calcification). In the setting of a comparative effectiveness study, we investigated the effect of oral calcitriol on fractures in HD patients taking into account a series of potential confounders. Method We conducted a secondary analysis of the VIKI database, a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers. Routine biochemistry and bone biochemical markers such as vitamin K levels, VKDPs, vitamin 25(OH)D, ALP, PTH, Ca, P, osteocalcin (BGP), Matrix Gla Protein (MGP) were assessed. The presence of Vertebral Fractures (VF) and Vascular Calcification (VC) was determined through spine radiograph. Reduction of &gt;20% of vertebral body height was considered a VF. The severity of the vertebral fractures was estimated as mild, moderate and severe (reduction: 20-25%, 25-40% or &gt;40%, respectively). VC were quantified by measuring the length of calcific deposits along the arteries (mild 0,1-5 cm, moderate 5,1-10 cm and severe &gt;10 cm). Results 177 out 387 patients (45.7%) were treated with oral calcitriol. Oral calcitriol-treated and untreated patients did not differ as for Ca, P, PTH, Albumin, BGP, MGP, and ALP. The prevalence of VF was significantly lower in patients receiving oral calcitriol than in those untreated (48.6% vs 61%, P=0.015), whereas the presence of aortic and iliac calcifications was similar between the two groups (aortic: 81.9% vs 79.5% respectively, P=0.552; iliac: 52.0% and 59.5%, P=0.167). No significant between-groups differences were observed in terms of calcification severity. In a multivariable logistic regression analysis, after adjustment for all potential confounders, oral calcitriol was associated with a marked reduction (-40.2%) of the odds of fractures (OR: 0.598, 95% CI: 0.363-0.985, P=0.043) (see Table). Conclusion A significant association was found between oral calcitriol and lower VF rate in HD patients. Such an effect remained significant also after data adjustment for a large series of potential confounders. Further prospective and interventional studies are needed to confirm these findings.

Stress, Coping, and Comorbidity among Hemodialysis Patients

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
S.-C.J. Yeh
Keyword(s):  
Coping Strategies ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Moderating Effect ◽  
Hierarchical Regression ◽  
Stress Coping ◽  
Cross Sectional ◽  
Face To Face ◽  
Positive Coping ◽  
The Relationship

Purposes:The primary purposes of this study were 1) to examine relationships among stress, coping and comorbidity and 2) to test the interaction effect of comorbidity.Background:Hemodialysis imposes a variety of physical and psychosocial stressors that challenge patients. Comorbidity is a risk factor for many health outcomes. Research on how comorbidity influences the relationship between coping and stress is limited.Method:In this cross-sectional study using face to face interviews, we interviewed 2642 hemodialysis patients fifteen years or older on dialysis for at least 3 months from October 2002 to January 2003. The Hemodialysis Stressor Scale measured stressors and the Jalowiec Coping Scale were used to measure coping strategies. A hierarchical regression was used to analyze the data.Results:Hemodialysis patients with comorbidities were found to have higher levels of stress. Comorbidity had a moderating effect between choice of problem-oriented responses and isolated thoughts as coping strategies. These findings show that hemodialysis patients with comorbidities often choose positive coping strategies.Conclusion:HD patients with comorbidity have a higher stress scores than those without comorbidities. Comorbidity not only has a direct impact on stress but also has a moderating effect on the relationship between coping and stress. Therefore, taking into account the comorbidity factor became very crucial when assessing the HD patients’ level of stress.

MO893ASSESSMENT OF PHYSICAL ACTIVITY IN CHRONIC HEMODIALYSIS PATIENTS IN THE NEPHROLOGY AND HEMODIALYSIS DEPARTEMENT CHU IBN ROCHD

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Imane Failal ◽  
Sanae Ezzaki ◽  
Marouane Sayeh ◽  
Salma Elkhayat ◽  
Ghizlaine Medkouri ◽  
...  
Keyword(s):  
Physical Activity ◽  
Excess Mortality ◽  
Leisure Activities ◽  
Cross Sectional Study ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Cross Sectional ◽  
Male Predominance ◽  
The Relationship

Abstract Background and Aims Physical activity is often reduced in chronic hemodialysis patients. Studies having evaluated hemodialysis reveal a significant sedentary lifestyle. which is associated with excess mortality. Conversely, the benefits in terms of morbidity and mortality from physical activity are numerous. The fight against sedentary lifestyles in hemodialysis patients must be one of the objectives of healthcare teams. For this reason, our study aims to assess physical inactivity using a physical activity score from DIJON in chronic hemodialysis patients and to identify the factors linked to a decrease in physical activity in them and to propose programs aimed at to encourage PA as well as exercises adapted to the hemodialysis patient. Method This is a descriptive and analytical cross-sectional study conducted during the month of January 2020, in the nephrology and hemodialysis department of CHU IBN ROCHD. We used the Dijon questionnaire translated into Arabic to measure the PA taking into account daily, sports or leisure activities. The PA level benchmarks are 0–10 (low), 10–20 (medium), and 20–30 (high). Results Our study included 71 patients. The average age was 46.5 years with extremes ranging from 16 to 93 years, there is a slight male predominance with a sex ratio of 1.1. Initial nephropathy was undetermined nephropathy in 53.5%, glomerular in 29.5%, diabetic in 7% and hypertensive in 1.4%. The age of the periodic hemodialysis treatment in our patients varied from 1 month to 44 years, with an average duration of 17.3 years. 91.5% of patients had an arteriovenous fistula as a vascular approach, 8.4% of patients were dialyzed on a catheter. The overall level of physical activity was high only in 4.5% of patients, while it was low in 61.3% and moderate in 34% of patients. The study of the relationship between the decrease in physical activity and different demographic, clinical and paraclinical parameters had revealed that the decrease in physical activity was significantly correlated with seniority on hemodialysis, gender, l he advanced age, the different degrees of anemia, and the cardiovascular affections, on the other hand no significant correlation was found between the decrease in physical activity and hypocalcemia, hyperphosphatemia, and hyperparathyroidism. Conclusion Our results show that the level of physical activity is linked to many parameters, some of which can be modified. Prescribing an adapted and personalized program would improve the prognosis related to co-morbidities and the quality of life of our patients.

scholarly journals Spirituality, moral injury and mental health among Chinese health professionals

BJPsych Open ◽  
2021 ◽  
Vol 7 (4) ◽  
Author(s):  
Zhizhong Wang ◽  
Faten Al Zaben ◽  
Harold G. Koenig ◽  
Yuanlin Ding
Keyword(s):  
Mental Health ◽  
Health Professionals ◽  
Mainland China ◽  
Cross Sectional Study ◽  
Moral Injury ◽  
Sectional Study ◽  
Cross Sectional ◽  
Health Crisis ◽  
Causal Nature ◽  
The Relationship

Background Moral injury has been found to be prevalent among healthcare professionals during the COVID-19 public health crisis. Aims The present study examines the relationship between spirituality, moral injury, and mental health among physicians and nurses in mainland China during the COVID-19 pandemic. Method An online cross-sectional study was conducted involving 3006 physicians and nurses in mainland China, where the COVID-19 pandemic has caused high rates of hospital admission and death. The Moral Injury Symptoms Scale-Health Professional was administered, along with measures of mental health and spirituality. Hierarchical linear regression modelling was used to examine the mediating and moderating role of moral injury in the relationship between spirituality and mental health. Results Spirituality was positively correlated with moral injury (β = 2.41, P < 0.01), depressive symptoms (β = 0.74, P < 0.01) and anxiety symptoms (β = 0.65, P < 0.01) after controlling sociodemographic variables. Moral injury significantly mediated the relationship between spirituality and both depression and anxiety, explaining 60% (0.46/0.76) of the total association between spirituality and depression and 58% (0.38/0.65) of the association with anxiety. No moderating effect of moral injury was found on the spirituality–mental health relationship. Conclusions Although they were the findings of a cross-sectional study, these results suggest that concern over transgressing moral values during the pandemic may have been a driving factor for negative mental health symptoms among Chinese health professionals for whom spirituality was somewhat important. Future longitudinal studies are needed to determine the causal nature of these relationships.

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