Vitamin K₂ Alters Bone Metabolism Markers in Hemodialysis Patients with a Low Serum Parathyroid Hormone Level

Abstract

Background: A low level of intact parathyroid hormone (PTH) is an indicator of adynamic bone disease in hemodialysis patients, and is associated with a significant increase of all-cause mortality. Thus, effective treatment for adynamic bone disease is required. We previously investigated the effect of vitamin K₂ on adynamic bone disease. In this study, we assessed the efficacy of oral vitamin K₂ in a controlled trial. Methods: Forty hemodialysis patients with low intact PTH levels (<100 pg/ml) were randomly divided into two groups, which were a vitamin K₂ group receiving oral menatetrenone (45 mg/day) for 1 year and a control group without vitamin K₂. Venous blood samples were collected at baseline and during the study for measurement of bone metabolism parameters. Results: Thirty-three patients completed follow-up. There was a significant increase of the serum intact osteocalcin level after 1 month of vitamin K₂ administration. Serum levels of intact PTH, bone alkaline phosphatase, and cross-linked N-terminal telopeptide of type I collagen increased significantly after 12 months in the vitamin K₂ group. The serum osteoprotegerin level was decreased after 12 months in the vitamin K₂ group, but the change was not significant. Conclusion: Vitamin K₂ therapy improves bone remodeling in hemodialysis patients with a low intact PTH level.

Effects of vitamin K supplementation on vascular calcification in chronic kidney disease: A systematic review and meta-analysis of randomized controlled trials

“…In all, the ten RCTs involved 733 patients, including 365 in interventional group and 367 in control groups. Among these studies, six were conducted in hemodialysis patients (13)(14)(15)(16)(17)(18)(19), two were conducted in non-dialysis CKD patients (20, 21), and one was conducted in kidney transplantation recipients (22). All studies were conducted in adult population, except for one study which had been conducted in pediatric population.…”

Mineral and bone disorders in conventional hemodialysis: Challenges and solutions

“…In Japan, vitamin K2 (menatetrenone) is indicated for osteoporosis. An RCT in patients on hemodialysis showed that 1‐year of menatetrenone (45 mg/day) treatment increased bone turnover markers along with intact PTH levels in patients with low PTH levels, which suggests the improvement of adynamic bone. From this perspective, vitamin K supplementation might be useful for preventing the progression of vascular calcification, especially that accompanying adynamic bone in humans.…”

“…In Japan, vitamin K2 (menatetrenone) is indicated for osteoporosis. An RCT in patients on hemodialysis showed that 1-year of menatetrenone (45 mg/day) treatment increased bone turnover markers along with intact PTH levels in patients with low PTH levels, 19 which suggests the improvement of adynamic bone.…”

Briefly Noted

“…In a randomized 1‐year trial of vitamin K 2 supplementation (menatetrenone 45 mg/day) in 33 patients on hemodialysis with adynamic bone disease (PTH ≤ 100 pg/ml), bone alkaline phophatase, serum PTH, and osteocalcin all increased significantly; these findings suggest improved bone remodeling (8).…”