Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross-Sectional Study.
CHRONIC KIDNEY DISEASE
DIALYSIS
ORAL CALCITRIOL
VASCULAR CALCIFICATION
VERTEBRAL FRACTURES
VITAMIN D
VITAMIN K
Journal
Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research
ISSN: 1523-4681
Titre abrégé: J Bone Miner Res
Pays: United States
ID NLM: 8610640
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
revised:
26
08
2021
received:
11
04
2021
accepted:
29
08
2021
pubmed:
9
10
2021
medline:
24
12
2021
entrez:
8
10
2021
Statut:
ppublish
Résumé
Fractures and vascular calcifications (VCs) are common in patients with chronic kidney disease (CKD). They are related to abnormalities in vitamin D metabolism, calcium, phosphorus, parathyroid hormone, and fibroblast growth factor 23 (FGF23)/Klotho that occur with CKD. Impaired vitamin D metabolism and abnormal levels of calcium, phosphate, parathyroid hormone (PTH), and FGF23/Klotho drive bone and vascular changes in CKD. It is unclear if oral calcitriol safely mitigates fracture risk without increasing the burden of calcifications. Therefore, we investigated whether treatment with calcitriol affected the prevalence of fractures and VC progression in hemodialysis (HD) patients. This report is a secondary analysis of the Vitamin K Italian (VIKI) study, a cross-sectional study involving 387 HD patients. We assessed vitamin 25(OH)D, alkaline phosphatase, PTH, calcium, phosphate, osteocalcin or bone Gla protein, matrix Gla protein, and vitamin K levels. Vertebral fractures (VFs) and VCs were determined by spine radiograph. A reduction of >20% of vertebral body height was considered a VF. VCs were quantified by the length of calcific lesions along the arteries. The patients treated with oral calcitriol were 177 of 387 patients (45.7%). The prevalence of VF was lower in patients receiving oral calcitriol than in those untreated (48.6% versus 61.0%, p = 0.015), whereas the presence of aortic and iliac calcifications was similar (aortic: 81.9% versus 79.5%, respectively, p = 0.552; iliac: 52.0% and 59.5%, respectively, p = 0.167). In multivariable logistic regression analysis, oral calcitriol was associated with a 40.2% reduced odds of fracture (OR 0.598; 95% confidence interval [CI], 0.363-0.985; p = 0.043). In conclusion, we found a significant association between oral calcitriol and lower VF in HD patients without an increase in the burden of VC. Further prospective and interventional studies are needed to confirm these findings. © 2021 American Society for Bone and Mineral Research (ASBMR).
Substances chimiques
Parathyroid Hormone
0
Vitamin K
12001-79-5
Vitamin D
1406-16-2
Fibroblast Growth Factor-23
7Q7P4S7RRE
Calcitriol
FXC9231JVH
Calcium
SY7Q814VUP
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2361-2370Informations de copyright
© 2021 American Society for Bone and Mineral Research (ASBMR).
Références
Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney Disease-mineral and bone disorder (CKD-MBD). Kidney Int Suppl. 2017;7(1):1-59.
Jadoul M, Albert JM, Akiba T, et al. Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int. 2006;70(7):1358-1366.
Rodríguez-García M, Gómez-Alonso C, Naves-Díaz M, et al. Vascular calcifications, vertebral fractures and mortality in haemodialysis patients. Nephrol Dial Transplant. 2009;24(1):239-246.
Beaubrun AC, Kilpatrick RD, Freburger JK, Bradbury BD, Wang L, Brookhart MA. Temporal trends in fracture rates and postdischarge outcomes among hemodialysis patients. J Am Soc Nephrol. 2013;24(9):1461-1469.
Tentori F, Mc Cullough K, Kilpatrick RD, et al. High rates of death and hospitalization follow bone fracture among hemodialysis patients. Kidney Int. 2014;85(1):166-173.
Matias PJ, Laranjinha I, Azevedo A, et al. Bone fracture risk factors in prevalent hemodialysis patients. J Bone Miner Metab. 2020;38(2):205-212.
Iseri K, Carrero JJ, Evans M, et al. Major fractures after initiation of dialysis: incidence, predictors and association with mortality. Bone. 2020;133:115242.
Evenepoel P, Opdebeeck B, David K, D'Haese PC. Bone-vascular axis in chronic kidney disease. Adv Chronic Kidney Dis. 2019;26(6):472-483.
Fusaro M, Noale M, Viola V, et al. Vitamin K, vertebral fractures, vascular calcifications, and mortality: VItamin K Italian (VIKI) dialysis study. J Bone Miner Res. 2012;27(11):2271-2278.
Wang Z, Jiang A, Wei F, Chen H. Cardiac valve calcification and risk of cardiovascular or all-cause mortality in dialysis patients: a meta-analysis. BMC Cardiovasc Disord. 2018;18(1):12.
Cano-Megías M, Guisado-Vasco P, Bouarich H, et al. Coronary calcification as a predictor of cardiovascular mortality in advanced chronic kidney disease: a prospective long-term follow-up study. BMC Nephrol. 2019;20(1):188.
Zhu X, Cai H, Zhu M, et al. Association of abdominal aortic calcification estimated by plain radiography with outcomes in haemodialysis patients: a 6-year follow-up study. Nephrology (Carlton). 2020;25(7):559-565.
Fusaro M, Tripepi G, Noale M, et al. High prevalence of vertebral fractures assessed by quantitative morphometry in hemodialysis patients, strongly associated with vascular calcifications. Calcif Tissue Int. 2013;93(1):39-47.
Vilaca T, Salam S, Schini M, et al. Risks of hip and nonvertebral fractures in patients with CKD G3a-G5D: a systematic review and meta-analysis. Am J Kidney Dis. 2020;76(4):521-532.
Reiss AB, Miyawaki N, Moon J, et al. CKD, arterial calcification, atherosclerosis and bone health: inter-relationships and controversies. Atherosclerosis. 2018;278:49-59.
Wang F, Wu S, Ruan Y, Wang L. Correlation of serum 25-hydroxyvitamin D level with vascular calcification in hemodialysis patients. Int J Clin Exp Med. 2015;8(9):15745-15751.
Fusaro M, Giannini S, Gallieni M, et al. Calcimimetic and vitamin D analog use in hemodialyzed patients is associated with increased levels of vitamin K dependent proteins. Endocrine. 2016;51(2):333-341.
Matias PJ, Ferreira C, Jorge C, et al. 25-Hydroxyvitamin D3, arterial calcifications and cardiovascular risk markers in haemodialysis patients. Nephrol Dial Transplant. 2009;24(2):611-618.
Molina P, Carrero JJ, Bover J, et al. Vitamin D, a modulator of musculoskeletal health in chronic kidney disease. J Cachexia Sarcopenia Muscle. 2017;8(5):686-701.
Peppone LJ, Hebl S, Purnell JQ, et al. The efficacy of calcitriol therapy in the management of bone loss and fractures: a qualitative review. Osteoporos Int. 2010;21(7):1133-1149.
Sadowski JA, Hood SJ, Dallal GE, Garry PJ. Phylloquinone in plasma from elderly and young adults: factors influencing its concentration. Am J Clin Nutr. 1989;50(1):100-108.
Genant HK, Jergas M, Palermo L, et al. Comparison of semiquantitative visual and quantitative morphometric assessment of prevalent and incident vertebral fractures in osteoporosis The Study of Osteoporotic Fractures Research Group. J Bone Miner Res. 1996;11(7):984-996.
Guglielmi G, Diacinti D, van Kuijk C, et al. Vertebral morphometry: current methods and recent advances. Eur Radiol. 2008;18(7):1484-1496.
Witteman JC, Grobbee DE, Valkenburg HA, et al. J-shaped relation between change in diastolic blood pressure and progression of aortic atherosclerosis. Lancet. 1994;343(8896):504-507.
Ureña-Torres PA, Vervloet M, Mazzaferro S, et al. Novel insights into parathyroid hormone: report of the parathyroid day in chronic kidney disease. Clin Kidney J. 2019;12(2):269-280.
Richy F, Ethgen O, Bruyere O, Reginster J-Y. Efficacy of alphacalcidol and calcitriol in primary and corticosteroid-induced osteoporosis: a meta-analysis of their effects on bone mineral density and fracture rate. Osteoporos Int. 2004;15(4):301-310.
O'Donnell S, Moher D, Thomas K, Hanley DA, Cranney A. Systematic review of the benefits and harms of calcitriol and alfacalcidol for fractures and falls. J Bone Miner Metab. 2008;26(6):531-542.
Tanakol R, Gül N, Üzüm AK, Aral F. Calcitriol treatment in patients with low vitamin D levels. Arch Osteoporos. 2018;13(1):114.
Montenegro KR, Cruzat V, Carlessi R, Newsholme P. Mechanisms of vitamin D action in skeletal muscle. Nutr Res Rev. 2019;32(2):192-204.
Erben RG. Update on FGF23 and Klotho signaling. Mol Cell Endocrinol. 2016;432:56-65.
Fretz JA, Zella LA, Kim S, Shevde NK, Pike JW. 1,25-Dihydroxyvitamin D3 regulates the expression of low-density lipoprotein receptor-related protein 5 via deoxyribonucleic acid sequence elements located downstream of the start site of transcription. Mol Endocrinol. 2006;20(9):2215-2230.
Nguyen-Yamamoto L, Karaplis AC, St-Arnaud R, Goltzman D. Fibroblast growth factor 23 regulation by systemic and local osteoblast-synthesized 1,25-dihydroxyvitamin D. J Am Soc Nephrol. 2017;28(2):586-597.
Ryan ZC, Ketha H, McNulty MS, et al. Sclerostin alters serum vitamin D metabolite and fibroblast growth factor 23 concentrations and the urinary excretion of calcium. Proc Natl Acad Sci U S A. 2013;110(15):6199-6204.
Fusaro M, D'Arrigo G, Pitino A, et al. Increased risk of bone fractures in hemodialysis patients treated with proton pump inhibitors in real world: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). J Bone Miner Res. 2019;34(12):2238-2245.
Xu L, Liu B, Li P, et al. Correlations of serum hormones and bone mineral density with fracture and balance ability of postmenopausal patients and effects of calcitriol. Med Sci Monit. 2018;24:7309-7315.
Vervloet M, Cozzolino M. Vascular calcification in chronic kidney disease: different bricks in the wall? Kidney Int. 2017;91(4):808-817.
Kwon YE, Choi HY, Oh HJ, Ahn SY, Ryu D-R, Kwon YJ. Vertebral fracture is associated with myocardial infarction in incident hemodialysis patients: a Korean nationwide population-based study. Osteoporos Int. 2020;31(10):1965-1973.
Mathew S, Lund RJ, Chaudhary LR, Geurs T, Hruska KA. Vitamin D receptor activators can protect against vascular calcification. J Am Soc Nephrol. 2008;19(8):1509-1519.
Lopez I, Mendoza FJ, Aguilera-Tejero E, et al. The effect of calcitriol, paricalcitol, and a calcimimetic on extraosseous calcifications in uremic rats. Kidney Int. 2008;73(3):300-307.
Guerrero F, Montes de Oca A, Aguilera-Tejero E, Zafra R, Rodríguez M, López I. The effect of vitamin D derivatives on vascular calcification associated with inflammation. Nephrol Dial Transplant. 2012;27(6):2206-2212.
Shroff R, Long DA, Shanahan C. Mechanistic insights into vascular calcification in CKD. J Am Soc Nephrol. 2013;24(2):179-189.
Mizobuchi M, Ogata H, Koiwa F, Kinugasa E, Akizawa T. Vitamin D and vascular calcification in chronic kidney disease. Bone. 2009;45:S26-S29.
Barreto DV, Barreto FC, Liabeuf S, et al. Vitamin D affects survival independently of vascular calcification in chronic kidney disease. Clin J Am Soc Nephrol. 2009;4(6):1128-1135.
Fusaro M, Gallieni M, Rebora P, et al. Atrial fibrillation and low vitamin D levels are associated with severe vascular calcifications in hemodialysis patients. J Nephrol. 2016;29(3):419-426.
Jokihaara J, Pörsti I, Pajamäki I, et al. Paricalcitol [19-nor-1,25-(OH)2D2] in the treatment of experimental renal bone disease. J Bone Miner Res. 2006;21(5):745-751.
Rix M, Eskildsen P, Olgaard K. Effect of 18 months of treatment with alfacalcidol on bone in patients with mild to moderate chronic renal failure. Nephrol Dial Transplant. 2004;19(4):870-876.
Ebeling PR, Wark JD, Yeung S, et al. Effects of calcitriol or calcium on bone mineral density, bone turnover, and fractures in men with primary osteoporosis: a two-year randomized, double blind, double placebo study. J Clin Endocrinol Metab. 2001;86(9):4098-4103.
Aloia JF, Vaswani A, Yeh JK, et al. Calcitriol in the treatment of postmenopausal osteoporosis. Am J Med. 1988;84(3 Pt 1):401-408.
Simes DC, Viegas CSB, Araújo N, Marreiros C. Vitamin K as a diet supplement with impact in human health: current evidence in age-related diseases. Nutrients. 2020;12(1):138.
Schurgers LJ, Teunissen KJF, Hamulyák K, Knapen MHJ, Vik H, Vermeer C. Vitamin K-containing dietary supplements: comparison of synthetic vitamin K1 and natto-derived menaquinone-7. Blood. 2007;109(8):3279-3283.
Fusaro M, Cianciolo G, Evenepoel P, Schurgers L, Plebani M. Vitamin K in CKD bone disorders. Calcif Tissue Int. 2021;108(4):476-485.
Ducy P, Desbois C, Boyce B, et al. Increased bone formation in osteocalcin-deficient mice. Nature. 1996;382(6590):448-452.
Fusaro M, Gallieni M, Porta C, Nickolas TL, Khairallah P. Vitamin K effects in human health: new insights beyond bone and cardiovascular health. J Nephrol. 2020;33(2):239-249.
Roumeliotis S, Dounousi E, Salmas M, Eleftheriadis T, Liakopoulos V. Vascular calcification in chronic kidney disease: the role of vitamin K- dependent matrix gla protein. Front Med (Lausanne). 2020;7:154.
Tabb MM, Sun A, Zhou C, et al. Vitamin K2 regulation of bone homeostasis is mediated by the steroid and xenobiotic receptor SXR. J Biol Chem. 2003;278(45):43919-43927.
Azuma K, Ouchi Y, Inoue S. Vitamin K: novel molecular mechanisms of action and its roles in osteoporosis. Geriatr Gerontol Int. 2014;14(1):1-7.
Tsugawa N, Shiraki M. Vitamin K nutrition and bone health. Nutrients. 2020;12(7):1909.
Ritter NM, Farach-Carson MC, Butler WT. Evidence for the formation of a complex between osteopontin and osteocalcin. J Bone Miner Res. 1992;7(8):877-885.
Hamidi MS, Gajic-Veljanoski O, Cheung AM. Vitamin K and bone health. J Clin Densitom. 2013;16(4):409-413.
Beulens JW, Bots ML, Atsma F, et al. High dietary menaquinone intake is associated with reduced coronary calcification. Atherosclerosis. 2009;203(2):489-493.
Bover J, Ureña P, Brandenburg V, et al. Adynamic bone disease: from bone to vessels in chronic kidney disease. Semin Nephrol. 2014;34(6):626-640.