scholarly journals Vitamin K Supplementation to Improve Vascular Stiffness in CKD: The K4Kidneys Randomized Controlled Trial

2020 ◽  
Vol 31 (10) ◽  
pp. 2434-2445
Author(s):  
Miles D. Witham ◽  
Jennifer S. Lees ◽  
Myra White ◽  
Margaret Band ◽  
Samira Bell ◽  
...  
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Meta Analysis ◽  
Vitamin K2 ◽  
Vascular Stiffness ◽  
Vascular Health ◽  
Ckd Stage ◽  
To Receive

BackgroundVascular calcification, a risk factor for cardiovascular disease, is common among patients with CKD and is an independent contributor to increased vascular stiffness and vascular risk in this patient group. Vitamin K is a cofactor for proteins involved in prevention of vascular calcification. Whether or not vitamin K supplementation could improve arterial stiffness in patients with CKD is unknown.MethodsTo determine if vitamin K supplementation might improve arterial stiffness in patients in CKD, we conducted a parallel-group, double-blind, randomized trial in participants aged 18 or older with CKD stage 3b or 4 (eGFR 15–45 ml/min per 1.73 m2). We randomly assigned participants to receive 400 μg oral vitamin K2 or matching placebo once daily for a year. The primary outcome was the adjusted between-group difference in carotid-femoral pulse wave velocity at 12 months. Secondary outcomes included augmentation index, abdominal aortic calcification, BP, physical function, and blood markers of mineral metabolism and vascular health. We also updated a recently published meta-analysis of trials to include the findings of this study.ResultsWe included 159 randomized participants in the modified intention-to-treat analysis, with 80 allocated to receive vitamin K and 79 to receive placebo. Mean age was 66 years, 62 (39%) were female, and 87 (55%) had CKD stage 4. We found no differences in pulse wave velocity at 12 months, augmentation index at 12 months, BP, B-type natriuretic peptide, or physical function. The updated meta-analysis showed no effect of vitamin K supplementation on vascular stiffness or vascular calcification measures.ConclusionsVitamin K2 supplementation did not improve vascular stiffness or other measures of vascular health in this trial involving individuals with CKD.Clinical Trial registry name and registration numberVitamin K therapy to improve vascular health in patients with chronic kidney disease, ISRCTN21444964 (www.isrctn.com)

Vitamin K Influence on Cardiovascular Mortality in Chronic Hemodialysed Patients

2017 ◽  
Vol 68 (1) ◽  
pp. 52-54 ◽  
Author(s):  
Daniela Radulescu ◽  
Andra Elena Balcangiu Stroescu ◽  
Catalin Pricop ◽  
Bogdan Geavlete ◽  
Carolina Negrei ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Vascular Calcification ◽  
Vitamin K ◽  
Cardiovascular Mortality ◽  
Dietary Intervention ◽  
Vitamin K2

Cardiovascular disease causes increased mortality in chronic hemodialysed patients. The decrease of vascular calcification is one of the main targets in the management of these patients. According to several experimental and clinical trials, choosing the proper diet and prescribing vitamin K2 supplements help to improve prognosis and decrease mortality, but further larger researchers are required to advocate the importance of this dietary intervention in hemodialysed population.

scholarly journals Vitamin K Dependent Proteins and the Role of Vitamin K2 in the Modulation of Vascular Calcification: A Review

2014 ◽  
Vol 29 (3) ◽  
pp. 172-177 ◽  
Author(s):  
Margueritta El Asmar ◽  
Joseph Naoum ◽  
Elias Arbid
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Vitamin K2

MO754THE INTERRELATIONSHIP BETWEEN FLUID OVERLOAD AND VASCULAR STIFFNESS IN HEMODIALYSIS PATIENTS: A SCOPING REVIEW

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Aya Lafta ◽  
Aminu Bello ◽  
Sara Davison ◽  
Stephanie Thompson ◽  
Branko Braam
Keyword(s):  
Pulse Wave Velocity ◽  
Wave Velocity ◽  
Scoping Review ◽  
Observational Studies ◽  
Pulse Wave ◽  
Fluid Overload ◽  
Augmentation Index ◽  
Extracellular Fluid ◽  
Vascular Stiffness

Abstract Background and Aims Fluid overload and vascular stiffness are two independent predictors of cardiovascular events in hemodialysis (HD) patients. To date, observational and interventional studies that investigated the effect of inter- and intradialytic fluid overload changes on vascular stiffness in HD patients are very limited. We performed a scoping review to explore existing reports about effects of fluid overload on vascular stiffness in adults receiving HD treatment and to identify knowledge gaps for future research. Method We followed the framework originally developed by Arksey and O’Malley. We searched Medline, Embase, CINAHL, and Cochrane Database of systematic reviews from inception to October 29, 2019. References of review papers were screened for relevant studies not identified from the initial search until saturation is achieved. Results Of 666 eligible studies, nineteen studies met the inclusion criteria. These included clinical observational studies (n=16) and randomized controlled trials (n=3). In general, most of the identified studies had small sample size and short term of follow up. Studies use different definitions of fluid overload and vascular stiffness. Measures of relative fluid overload like the ratio of extracellular fluid/intracellular fluid, fluid overload/extracellular fluid, and/or extracellular fluid/total body fluid were used as a representative of fluid status. Pulse wave velocity and augmentation index were used interchangeably as vascular stiffness measures. The accumulated findings were inconsistent and inconclusive. There was no consensus whether intradialytic fluid volume changes affected vascular stiffness. In the majority of the observational studies, a decrease in pulse wave velocity or augmentation index correlated with a decrease in blood pressure after fluid correction by HD treatment. The randomized clinical trials used different methods and technologies for the correction of fluid overload, thereby, results were conflicting. Conclusion Current literature is insufficient to justify whether fluid overload changes have a direct effect on vascular stiffness in HD patients. The findings were conflicting which limits the comparisons of studies and generalization of findings. These knowledge gaps urge the need for further clinical studies to enhance the understanding and to improve the quality of research in this topic. This includes standardized definitions and methodologies as well as longer term of follow up.

scholarly journals Multicenter Randomized Controlled Trial of Vitamin K Antagonist Replacement by Rivaroxaban with or without Vitamin K2 in Hemodialysis Patients with Atrial Fibrillation: the Valkyrie Study

2019 ◽  
Vol 31 (1) ◽  
pp. 186-196 ◽  
Author(s):  
An S. De Vriese ◽  
Rogier Caluwé ◽  
Lotte Pyfferoen ◽  
Dirk De Bacquer ◽  
Koen De Boeck ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulse Wave Velocity ◽  
Thoracic Aorta ◽  
Wave Velocity ◽  
Vitamin K ◽  
Pulse Wave ◽  
Vitamin K2 ◽  
Favorable Effect ◽  
Bleeding Complications ◽  
Multicenter Randomized Controlled Trial

BackgroundVitamin K antagonists (VKAs), although commonly used to reduce thromboembolic risk in atrial fibrillation, have been incriminated as probable cause of accelerated vascular calcification (VC) in patients on hemodialysis. Functional vitamin K deficiency may further contribute to their susceptibility for VC. We investigated the effect of vitamin K status on VC progression in 132 patients on hemodialysis with atrial fibrillation treated with VKAs or qualifying for anticoagulation.MethodsPatients were randomized to VKAs with target INR 2–3, rivaroxaban 10 mg daily, or rivaroxaban 10 mg daily plus vitamin K2 2000 µg thrice weekly during 18 months. Systemic dp-ucMGP levels were quantified to assess vascular vitamin K status. Cardiac and thoracic aorta calcium scores and pulse wave velocity were measured to evaluate VC progression.ResultsBaseline dp-ucMGP was severely elevated in all groups. Initiation or continuation of VKAs further increased dp-ucMGP, whereas levels decreased in the rivaroxaban group and to a larger extent in the rivaroxaban+vitamin K2 group, but remained nevertheless elevated. Changes in coronary artery, thoracic aorta, and cardiac valve calcium scores and pulse wave velocity were not significantly different among the treatment arms. All cause death, stroke, and cardiovascular event rates were similar between the groups. Bleeding outcomes were not significantly different, except for a lower number of life-threatening and major bleeding episodes in the rivaroxaban arms versus the VKA arm.ConclusionsWithdrawal of VKAs and high-dose vitamin K2 improve vitamin K status in patients on hemodialysis, but have no significant favorable effect on VC progression. Severe bleeding complications may be lower with rivaroxaban than with VKAs.

scholarly journals Vitamins K1 and K2: The Emerging Group of Vitamins Required for Human Health

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Gerry Kurt Schwalfenberg
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Warfarin Therapy ◽  
Cardiovascular Health ◽  
Coronary Calcification ◽  
Renal Calculi ◽  
Bisphosphonate Therapy ◽  
Vitamin K2 ◽  
Level I ◽  
Clinical Conditions

Objective. To review the evidence for the use of vitamin K supplementation in clinical conditions such as osteoporosis, vascular calcification, arthritis, cancer, renal calculi, diabetes, and warfarin therapy.Quality of Evidence. PubMed was searched for articles on vitamin K (K1 and K2) along with books and conference proceedings and health conditions listed above. Level I and II evidence supports the use of vitamins K1 and K2 in osteoporosis and Level II evidence supports vitamin K2 in prevention of coronary calcification and cardiovascular disease. Evidence is insufficient for use in diabetes, arthritis, renal calculi, and cancer.Main Message.Vitamin K2 may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity. It may also significantly reduce morbidity and mortality in cardiovascular health by reducing vascular calcification. Vitamin K2 appears promising in the areas of diabetes, cancer, and osteoarthritis. Vitamin K use in warfarin therapy is safe and may improve INR control, although a dosage adjustment is required.Conclusion. Vitamin K supplementation may be useful for a number of chronic conditions that are afflicting North Americans as the population ages. Supplementation may be required for bone and cardiovascular health.

scholarly journals SO083VASCULAR STIFFNESS ESTIMATED NON-INVASIVELY USING PULSE WAVE PROPAGATION CORRESPONDS TO VASCULAR BIOPSY FINDINGS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Malgorzata Debowska ◽  
Bengt Lindholm ◽  
Lu Dai ◽  
Jacek Waniewski ◽  
Abdul Rashid Tony Qureshi ◽  
...  
Keyword(s):  
Mathematical Model ◽  
Wave Propagation ◽  
Vascular Calcification ◽  
Pulse Pressure ◽  
Pulse Wave ◽  
Vascular Stiffness ◽  
Patient Specific ◽  
P Value ◽  
Pulse Wave Propagation ◽  
Pressure Profiles

Abstract Background and Aims Patients with chronic kidney disease (CKD) are at high risk of cardiovascular disease (CVD) due to complex processes in the uremic milieu linked to CKD - mineral and bone disorders (CKD-MBD). These processes alter structure and function of heart and vasculature e.g. by causing ectopic calcification that makes vessels stiffer thus affecting pulse (pressure) wave profiles. Our study aimed to derive patient-specific parameters using pulse wave propagation model including arterial stiffness and compare those parameters with cardiovascular status including biopsy proven severity of vascular calcification. Method In a group of 81 CKD (stage 5) patients undergoing living donor kidney transplantation, the degree of medial calcification in epigastric artery was histologically graded as 0 (n=22), 1 (n=31), 2 (n=21) and 3 (n=7) representing no, minimal, moderate and extensive signs of vascular calcification, respectively. Concomitantly 82 features were determined including demographic and anthropometric features, blood biomarkers related to CKD - MBD and other measurements. Pressure profiles (circles in Fig. 1) in radial artery were recorded using applanation tonometer (SphygmoCor, AtCor Medical, Australia) and used to derive patient-specific parameters from a mathematical model describing blood flow and pressure in 55 major arteries. Results The model was able to reproduce all recorded pressure profiles with high accuracy with average relative error less than 8% (compare solid line and circles in Fig. 1). Vascular stiffness, derived from the model, in arterial branches located in the area of artery for which calcification was histologically quantified, was significantly higher for higher calcification score (p-value < 0.001). The estimated stiffness correlated with the level of troponin T (rho=0.65**), advanced glycation end-products (by skin autofluorescence, rho=0.55*), osteoprotegerin (rho=0.44**), hepcidin 25 (rho=0.32*, interleukin 6 (rho=0.29*) and choline (rho=0.28**), (‘**’ and ‘*’ denote p-value < 0.01 and 0.05, respectively). Stiffer arteries were found in patients with diagnosed CVD (p-value < 0.01). Conclusion We demonstrate that a mathematical model based on a single peripheral recording of pulse pressure profile has the potential to provide information about cardiovascular status in the individual patient. Also, the estimated stiffness correlates well with several well-established CVD risk factors. Our mathematical model of the arterial tree, if validated in larger cohorts of patients, may be used as computational tool to predict vascular stiffness without need of arterial biopsy.

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

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0247623
Author(s):  
Lu Dai ◽  
Longkai Li ◽  
Helen Erlandsson ◽  
Armand M. G. Jaminon ◽  
Abdul Rashid Qureshi ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Vitamin K ◽  
Matrix Gla Protein ◽  
Vitamin K Deficiency ◽  
Increased Risk ◽  
Ckd Stage ◽  
All Cause Mortality ◽  
K Deficiency

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.

scholarly journals Locking and loading the bullet against micro-calcification

2020 ◽  
pp. 204748732091113 ◽  
Author(s):  
Alexandru Florea ◽  
Agnieszka Morgenroth ◽  
Jan Bucerius ◽  
Leon J Schurgers ◽  
Felix M Mottaghy
Keyword(s):  
Vascular Calcification ◽  
Vitamin K ◽  
Sodium Fluoride ◽  
Meta Analysis ◽  
Treatment Options ◽  
Cost Effective ◽  
Positron Emission ◽  
Effective Option ◽  
Pubmed Search ◽  
Medical Advances

Aims Despite recent medical advances, cardiovascular disease remains the leading cause of death worldwide. As (micro)-calcification is a hallmark of atherosclerosis, this review will elaborately discuss advantages of sodium fluoride positron emission tomography (PET) as a reliable cardiovascular imaging technique for identifying the early onset of vascular calcification (i.e. locking onto the target). We assess state-of-the-art meta-analysis and clinical studies of possible treatment options and evaluate the concept of vitamin K supplementation to preserve vascular health (i.e. loading the bullet). Methods and results After a structured PubMed search, we identified 18F-sodium fluoride (18F-NaF) PET as the most suitable technique for detecting micro-calcification. Presenting the pros and cons of available treatments, vitamin K supplementation should be considered as a possible safe and cost-effective option to inhibit vascular (micro)-calcification. Conclusion This review demonstrates need for more extensive research in the concept of vitamin K supplementation (i.e. loading the bullet) and recommends monitoring the effects on vascular calcification using 18F-NaF PET (i.e. locking onto the target).

scholarly journals Clinical and diagnostical value of 24-hour arterial stiffness monitoring in patients with bronchial asthma

2020 ◽  
Vol 92 (3) ◽  
pp. 30-35
Author(s):  
N. A. Karoli ◽  
O. T. Zarmanbetova ◽  
A. P. Rebrov
Keyword(s):  
Arterial Stiffness ◽  
Pulse Wave Velocity ◽  
Severe Asthma ◽  
Bronchial Asthma ◽  
Wave Velocity ◽  
Pulse Wave ◽  
Augmentation Index ◽  
Vascular Stiffness ◽  
Moderate Asthma ◽  
And Control

Aim. To evaluate 24-hour dynamics of the arterial stiffness main indicators in patients with bronchial asthma of various severity and control. Materials and methods. The study included 119 patients with bronchial asthma, who formed main groups: the first group 48 patients with mild and moderate asthma, the second 71 patients with severe asthma. All patients underwent the vascular stiffness parameters study using a multifunctional complex for the 24-hour monitoring and office measurements of blood pressure and vessels condition. At the same time vascular stiffness indicators were examined: PWVao pulse wave velocity in the aorta (m/s); Aix augmentation index (%); ASI the arterial stiffness index (mmHg). Results. When comparing the 24-hour arterial stiffness dynamics indicators, changes were found in patients with severe asthma and non-control. Thus, a statistically significant increase in the pulse wave velocity in the aorta and augmentation index in second group compared to patients of the 1st group and control subjects. In patients with severe asthma Aix at night is significantly higher than daytime, which indicates an increase in arterial stiffness at night. Conclusions. Patients with severe bronchial asthma have increased arterial stiffness in comparison with controls and mild and moderate asthma. Also, in patients with severe asthma arterial stiffness parameters were higher at night-time in comparison with daytime.

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