High Dephosphorylated-Uncarboxylated MGP in Hemodialysis patients: risk factors and response to vitamin K 2 , A pre-post intervention clinical trial

Vascular calcifications are highly prevalent in hemodialysis patients. Dephosphorylated-uncarboxylated MGP (dp-ucMGP) was found to increase in vitamin K-deficient patients and may be associated with vascular calcifications. Supplementation of hemodialysis patients with vitamin K (menaquinone-7) has...

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Bibliographic Details
Published in:BMC nephrology 2017-06, Vol.18 (1), p.191
Main Authors: Aoun, Mabel, Makki, Maha, Azar, Hiba, Matta, Hiam, Chelala, Dania Nehme
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Biomarkers - blood
Calcium-Binding Proteins - blood
Extracellular Matrix Proteins - blood
Female
Humans
Male
Matrix Gla Protein
Middle Aged
Phosphorylation - physiology
Prospective Studies
Renal Dialysis - adverse effects
Renal Dialysis - trends
Risk Factors
Treatment Outcome
Vitamin K 2 - therapeutic use
Vitamin K Deficiency - blood
Vitamin K Deficiency - drug therapy
Vitamin K Deficiency - etiology
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Summary:Vascular calcifications are highly prevalent in hemodialysis patients. Dephosphorylated-uncarboxylated MGP (dp-ucMGP) was found to increase in vitamin K-deficient patients and may be associated with vascular calcifications. Supplementation of hemodialysis patients with vitamin K (menaquinone-7) has been studied in Europe with a maximum 61% drop of dp-ucMGP levels. The aim of this study is to assess first the drop of dp-ucMGP in an Eastern Mediterranean cohort after vitamin K treatment and second the correlation between baseline dp-ucMGP and vascular calcification score. This is a prospective, pre-post intervention clinical trial involving 50 hemodialysis patients who received daily 360 μg of menaquinone-7 for 4 weeks. At baseline they were assessed for plasma dp-ucMGP levels and vascular calcification scores (AC-24) as well as for other demographic, clinical and biological variables. Dp-ucMGP levels were measured a second time at 4 weeks. At baseline, dp-ucMGP levels were extremely elevated with a median of 3179.15 (1825.25; 4339.50) pM and correlated significantly with AC-24 (Spearman's rho = 0.43, P = 0.002). Using a bivariate regression analysis, the association between dp-ucMGP levels and AC-24 was most significant when comparing dp-ucMGP levels less than 1000 to those more than 1000 pM (P = 0.02). Dp-ucMGP levels higher than 5000 pM were significantly associated with females, patients with recent fracture and patients with lower serum albumin (respectively P = 0.02, 0.004 and 0.046). The average drop of dp-ucMGP at 4 weeks of treatment was found to be 86% with diabetics having the lowest drop rate (P = 0.01). Vitamin K deficiency, as assessed by high dp-ucMGP levels, is profound in hemodialysis patients from the Eastern Mediterranean region and it is significantly correlated with vascular calcifications. Daily 360 μg of menaquinone-7, given for 4 weeks, effectively reduces dp-ucMGP in this population. Future studies are needed to assess the changes in vascular calcifications in hemodialysis patients treated with vitamin K over a longer follow-up period. The clinical trial was registered on clinicaltrials.gov (Identification number NCT02876354 , on August 11, 2016).
ISSN:1471-2369
DOI:10.1186/s12882-017-0609-3