Association of Vitamin K Status with Arterial Calcification and Stiffness in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort

M Kyla Shea; Jifan Wang; Kathryn Barger; Daniel E Weiner; Raymond R Townsend; Harold I Feldman; Sylvia E Rosas; Jing Chen; Jiang He; John Flack; Bernard G Jaar; Mayank Kansal; Sarah L Booth; CRIC Study Investigators

doi:10.1016/j.cdnut.2022.100008

Association of Vitamin K Status with Arterial Calcification and Stiffness in Chronic Kidney Disease: The Chronic Renal Insufficiency Cohort

Curr Dev Nutr. 2022 Dec 23;7(1):100008. doi: 10.1016/j.cdnut.2022.100008. eCollection 2023 Jan.

Authors

Affiliations

¹ USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
² Division of Nephrology, Tufts Medical Center, Boston, MA, USA.
³ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Joslin Diabetes Center, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
⁵ Department of Epidemiology, Tulane University School of Medicine, New Orleans, LA, USA.
⁶ Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, IL, USA.
⁷ Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
⁸ Department of Medicine, University of Illinois-Chicago, Chicago, IL, USA.

Abstract

Background: Arterial calcification and stiffness are common in people with chronic kidney disease (CKD). Higher vitamin K status has been associated with less arterial calcification and stiffness in CKD in cross-sectional studies.

Objectives: To determine the association of vitamin K status with coronary artery calcium (CAC) and arterial stiffness [pulse wave velocity (PWV)] at baseline and over 2-4 follow-up years in adults with mild-to-moderate CKD.

Methods: Participants (n = 2722) were drawn from the well-characterized Chronic Renal Insufficiency Cohort. Two vitamin K status biomarkers, plasma phylloquinone and plasma dephospho-uncarboxylated matrix gla protein [(dp)ucMGP], were measured at baseline. CAC and PWV were measured at baseline and over 2-4 y of follow-up. Differences across vitamin K status categories in CAC prevalence, incidence, and progression (defined as ≥100 Agatston units/y increase) and PWV at baseline and over follow-up were evaluated using multivariable-adjusted generalized linear models.

Results: CAC prevalence, incidence, and progression did not differ across plasma phylloquinone categories. Moreover, CAC prevalence and incidence did not differ according to plasma (dp)ucMGP concentration. Compared with participants with the highest (dp)ucMGP (≥450 pmol/L), those in the middle category (300-449 pmol/L) had a 49% lower rate of CAC progression (incidence rate ratio: 0.51; 95% CI: 0.33, 0.78). However, CAC progression did not differ between those with the lowest (<300 pmol/L) and those with the highest plasma (dp)ucMGP concentration (incidence rate ratio: 0.82; 95% CI: 0.56, 1.19). Neither vitamin K status biomarker was associated with PWV at baseline or longitudinally.

Conclusions: Vitamin K status was not consistently associated with CAC or PWV in adults with mild-to-moderate CKD.

Keywords: arterial calcification; arterial stiffness; chronic kidney disease; matrix gla protein; vascular calcification; vitamin K.

Grants and funding

P20 GM109036/GM/NIGMS NIH HHS/United States