Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
Korean J Intern Med. 2019 May;34(3):459-469. doi: 10.3904/kjim.2019.125. Epub 2019 Apr 30.
Vascular calcification (VC) and malnutrition associated with cardiovascular disease are common in patients with chronic kidney disease (CKD) treated with dialysis. VC, which reflects vascular aging, and malnutrition are also encountered in the non-CKD elderly population. This similarity of clinical findings suggests that the progression of CKD is related to aging and the existence of a causal relationship between VC and malnutrition. To retard renal progression, a low- or very-low-protein diet is usually recommended for CKD patients. Dietary education may induce malnutrition and deficiency of important nutrients, such as vitamins K and D. Menaquinone-7, a type of vitamin K2, is under investigation for inhibiting VC in elderly patients without CKD, as well as for prevention of VC in patients with CKD. Nutritional vitamin D, such as cholecalciferol, may be considered to decrease the required dose of active vitamin D, which increases the risk of VC due to increased calcium and phosphate loads. Omega-3 fatty acids are important nutrients and their ability to inhibit VC needs to be evaluated in clinical trials. This review focuses on the ability of supplementary nutrients to prevent VC in patients with CKD, in whom dietary restriction is essential.
血管钙化（VC）和与心血管疾病相关的营养不良在接受透析治疗的慢性肾脏病（CKD）患者中很常见。反映血管老化的 VC 和营养不良也存在于非 CKD 老年人群中。这些临床发现的相似性表明，CKD 的进展与衰老有关，并且 VC 和营养不良之间存在因果关系。为了延缓肾脏进展，通常建议 CKD 患者采用低蛋白或极低蛋白饮食。饮食教育可能会导致营养不良和重要营养素（如维生素 K 和 D）的缺乏。甲萘醌-7 是一种维生素 K2，正在研究用于抑制无 CKD 的老年患者的 VC，以及预防 CKD 患者的 VC。营养性维生素 D，如胆钙化醇，可考虑减少活性维生素 D 的所需剂量，因为活性维生素 D 会增加钙和磷酸盐负荷，从而增加 VC 的风险。ω-3 脂肪酸是重要的营养素，需要在临床试验中评估其抑制 VC 的能力。本综述重点介绍补充营养素预防 CKD 患者 VC 的能力，因为饮食限制在 CKD 患者中至关重要。
