3048C Etherington Hall, Queen's University, Kingston, ON, Canada K7L 3V6.
Clin J Am Soc Nephrol. 2010 Apr;5(4):590-7. doi: 10.2215/CJN.06420909. Epub 2010 Feb 18.
Vitamin K, vitamin K-dependent proteins, and vitamin D may be involved in the regulation of calcification in chronic kidney disease (CKD).
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Vitamin K and D status was measured as dietary intake, plasma phylloquinone, serum percent uncarboxylated osteocalcin (%ucOC), proteins induced by vitamin K absence (PIVKA-II), Vitamin K Epoxide Reductase single-nucleotide polymorphism, apolipoprotein E genotype, and plasma 25-hydroxyvitamin D (25(OH)D) in 172 subjects with stage 3 to 5 CKD. Nutritional status was determined by subjective global assessment.
Subclinical vitamin K deficiency criteria was met by 6% (phylloquinone), 60% (%ucOC), and 97% (PIVKA-II) of subjects, whereas 58.3% and 8.6% had 25(OH)D insufficiency and deficiency, respectively. Dietary vitamin K intake was associated with higher phylloquinone and lower PIVKA-II. There were positive correlations between phylloquinone and the presence of stable weight, and the absence of subcutaneous fat loss or muscle wasting. 25(OH)D levels were positively associated with stable weight and albumin (P < 0.001). PIVKA-II levels were associated with apolipoprotein E genotype. Higher %ucOC and lower 25(OH)D were similarly associated with CKD stage, parameters of mineral metabolism, and urine albumin to creatinine ratio.
These data indicate that a suboptimal vitamin K and D status is prevalent in patients with CKD. Sufficiency of both vitamins K and D was similarly predicted by measures of overall improved nutritional status. Proteinuria was associated with both a suboptimal vitamin D status as well as worse peripheral vitamin K status.
维生素 K、维生素 K 依赖性蛋白和维生素 D 可能参与了慢性肾脏病（CKD）中钙沉积的调节。
设计、地点、参与者和测量方法：在 172 名 CKD 3 至 5 期患者中，通过膳食摄入、血浆叶绿醌、血清未羧化骨钙素百分比（%ucOC）、维生素 K 缺乏诱导蛋白（PIVKA-II）、维生素 K 环氧化物还原酶单核苷酸多态性、载脂蛋白 E 基因型和血浆 25-羟维生素 D（25(OH)D）来衡量维生素 K 和 D 状态。营养状况通过主观全面评估来确定。
6%（叶绿醌）、60%（%ucOC）和 97%（PIVKA-II）的患者符合亚临床维生素 K 缺乏标准，而 58.3%和 8.6%的患者分别存在 25(OH)D 不足和缺乏。维生素 K 的膳食摄入量与较高的叶绿醌和较低的 PIVKA-II 有关。叶绿醌与稳定体重、无皮下脂肪减少或肌肉减少呈正相关。25(OH)D 水平与稳定体重和白蛋白呈正相关（P<0.001）。PIVKA-II 水平与载脂蛋白 E 基因型有关。较高的 %ucOC 和较低的 25(OH)D 与 CKD 分期、矿物质代谢参数和尿白蛋白/肌酐比也有类似的相关性。
这些数据表明，CKD 患者普遍存在维生素 K 和 D 摄入不足的情况。两种维生素 K 和 D 的充足性同样可以通过整体营养状况的改善来预测。蛋白尿与维生素 D 状态不佳以及外周维生素 K 状态恶化均有关。
