Vitamin K supplementation and bone mineral density in dialysis: results of the double-blind, randomized, placebo-controlled RenaKvit trial

Karin Levy-Schousboe*, Peter Marckmann, Marie Frimodt-Møller, Christian D. Peters, Krista D. Kjærgaard, Jens D. Jensen, Charlotte Strandhave, Hanne Sandstrøm, Mette F. Hitz, Bente Langdahl, Peter Vestergaard, Claus L. Brasen, Anne Schmedes, Jonna S. Madsen, Niklas R. Jørgensen, Jens B. Frøkjær, Niels E. Frandsen, Inge Petersen, Ditte Hansen

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

BACKGROUND: Vitamin K deficiency is highly prevalent in patients on dialysis and may contribute to their low bone mineral density (BMD) and increased risk of fracture. This study investigated the effect of menaquinone-7 (MK-7) supplementation on BMD in patients on chronic dialysis.

METHODS: In a multicentre, double-blind, placebo-controlled intervention trial, 123 patients on chronic dialysis were randomised to a daily oral supplement of either MK-7 360 µg or placebo for 2 years. BMD of the distal radius (1/3, mid, ultradistal and total), femoral neck, lumbar spine (L1-L4) and whole body was assessed by dual-energy X-ray absorptiometry. Serum levels of vitamin K1 and MK-7 and plasma levels of total osteocalcin, dephosphorylated-uncarboxylated matrix Gla protein and protein induced by vitamin K absence II were measured to assess vitamin K status.

RESULTS: After 2 years, an accelerated BMD loss of the 1/3 distal radius was found with MK-7 supplementation {mean difference of changes relative to placebo -0.023 g/cm2 [95% confidence interval (CI) -0.039 to -0.008]}, whereas the decrease in lumbar spine BMD seen in the placebo group was prevented [mean difference of changes between groups 0.050 g/cm2 (95% CI 0.015-0.085)]. No significant effects were observed at the remaining skeletal sites. Vitamin K status strongly improved in MK-7-supplemented participants.

CONCLUSION: Compared with placebo, an accelerated BMD loss of the 1/3 distal radius was found after 2 years of MK-7 supplementation, whereas a decline in lumbar spine BMD was prevented. As such, MK-7 supplementation might modify BMD site-specifically in patients on dialysis. In aggregate, our findings do not support MK-7 supplementation to preserve bone in patients on dialysis.

OriginalsprogEngelsk
Artikelnummergfac315
TidsskriftNephrology, Dialysis, Transplantation
Vol/bind38
Udgave nummer10
Sider (fra-til)2131–2142
Antal sider12
ISSN0931-0509
DOI
StatusUdgivet - okt. 2023

Bibliografisk note

© The Author(s) 2022. Published by Oxford University Press on behalf of the ERA.

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