Emerging Role of Vitamins D and K in Modulating Uremic Vascular Calcification: The Aspect of Passive Calcification.

Yi-Chou Hou,Yuh-Feng Lin,Tzung-Hai Yen,Chien-Lin Lu,Ruei-Ming Chen,Remy Chen,Kuo-Cheng Lu,Wen-Chih Liu,Cai-Mei Zheng

doi:10.3390/nu11010152

Abstract

Vascular calcification is a critical complication in patients with chronic kidney disease (CKD) because it is predictive of cardiovascular events and mortality. In addition to the traditional mechanisms associated with endothelial dysfunction and the osteoblastic transformation of vascular smooth muscle cells (VSMCs), the regulation of calcification inhibitors, such as calciprotein particles (CPPs) and matrix vesicles plays a vital role in uremic vascular calcification in CKD patients because of the high prevalence of vitamin K deficiency. Vitamin K governs the gamma-carboxylation of matrix Gla protein (MGP) for inhibiting vascular calcification, and the vitamin D binding protein receptor is related to vitamin K gene expression. For patients with chronic kidney disease, adequate use of vitamin D supplements may play a role in vascular calcification through modulation of the calciprotein particles and matrix vesicles (MVs).

Highlights

Chronic kidney disease (CKD) is defined as a progressive decline in the glomerular filtration rate
The accumulated phosphate activates the osteogenic differentiation of vascular smooth muscle cells (VSMCs) directly or through the activation of the renin–angiotensin–aldosterone system (RAAS), which is related to the inflammation process [17]
No and kidney of adenine-treated rats. This decreased γ-carboxylase activity was associated with aortic direct evidence has demonstrated the uremic milieu’s influence on γ-carboxylase activity within tissues or γ-carboxylase activity expression in humans, vitamin K deficiency is common in chronic kidney disease (CKD) patients

Summary

Introduction

Chronic kidney disease (CKD) is defined as a progressive decline in the glomerular filtration rate. Patients with CKD have a higher mortality rate, and cardiovascular disease is the major cause of death among these patients [1]. Vascular calcification is predictive of poor prognoses and clinical outcomes in CKD patients, such as overall mortality and even poor arteriovenous graft maturation [5,6]. C-reactive protein (hsCRP) for cardiovascular disease [8]. Supplement of calcification inhibitors such as carboxylated GRP should play a role in alleviating systemic calcification in CKD patients [13]. Since vitamin K governs gamma-carboxylation of matrix Gla protein, we would to elucidate the relationship between vitamin K deficiency and uremic calcification, as well as the role of vitamin supplements in the prevention of uremic vascular calcification

The Traditional Aspect

The New Aspect

Vitamin D and K Deficiencies in CKD as an Etiology of Vascular Calcification

Findings

Conclusions