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Vascular calcification in chronic kidney disease: the role of vitamin K

Nature Clinical Practice Nephrology volume 3, pages 522–523 (2007)Cite this article

The majority of patients who have advanced chronic kidney disease requiring dialysis will die as a result of a cardiovascular event. Cardiovascular disease in the dialysis population is complex, and therapies proven to reduce cardiovascular mortality in the general population, such as HMG-CoA reductase inhibitors, do not seem to have the same benefit in the dialysis setting.1 Although traditional risk factors for atherosclerosis are important in patients on dialysis, uremia-specific risk factors also contribute substantially to vascular calcification and the burden of cardiovascular disease. Risk factors for vascular calcification, such as increased dialysis vintage, elevated serum phosphorus concentrations and higher prescribed daily doses of vitamin D and calcium-containing phosphate binders, are unique to the dialysis population. It is, therefore, important to consider risk factors from outside the traditional paradigm of cardiovascular risk reduction when caring for the dialysis patient. In this Viewpoint, we discuss the rationale for the hypothesis that vitamin K is a modifiable risk factor for vascular calcification in patients on dialysis.

Vascular calcification is an active cell-mediated process that seems to be driven by hyperphosphatemia.2 During vascular calcification, vascular smooth muscle cells transform into osteoblast-like cells that become capable of expressing proteins that regulate mineralization. One of these proteins—matrix Gla protein (MGP)—is an inhibitory regulator of tissue mineralization in the arterial wall. Vitamin K serves as a cofactor in the enzymatic reaction that converts specific glutamate residues in MGP into γ-carboxyglutamic acid residues, which are required for its calcium-binding capacity.3

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Authors and Affiliations

  1. RM Holden is a Nephrologist and Assistant Professor of Medicine at Queen's University in Kingston, ON, Canada.,

    Rachel M Holden

  2. SL Booth is the Director of the Vitamin K Research Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA.,

    Sarah L Booth

Authors
  1. Rachel M Holden
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  2. Sarah L Booth
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Correspondence to Rachel M Holden.

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The authors declare no competing financial interests.

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Holden, R., Booth, S. Vascular calcification in chronic kidney disease: the role of vitamin K. Nat Rev Nephrol 3, 522–523 (2007). https://doi.org/10.1038/ncpneph0601

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