Vitamin K2 and Vessel Calcification in Chronic Kidney Disease Patients (CACSK2)

Influence of Vitamin K2 Administration on Vessel Calcification Markers in Patients With Chronic Kidney Disease

Vessel calcification is a recognised cardiovascular morbidity risk factor in patients with chronic kidney disease (CKD). Recent reports indicate a significant role of Matrix Gla-protein (MGP) in decreasing calcification processes. MGP is excretion protein whose mechanism of action is not yet fully explained and which to be activated requires phosphorylation and carboxylation where cofactor is vitamin K. These observations indicate that shortage of vitamin K is a significant risk factor for the development of vessel calcification. Another calcification risk factor in CKD patients are calcium-phosphate disturbances and insufficiency of vitamin D3 which in physiological concentration stimulates MGP transcription. The aim of this study is estimation of influence of vitamin K2 administration over the period of 9 months on vessel calcification in 3.- 5. stage CKD patients.

It is a prospective, randomised double-blind study carried out in parallel groups. 60 patients with CKD (GFR 15-60 ml/min) with calcium score >10 (Agatston scoring system) will be qualified for the study. On the basis of randomised selection, patients will be divided into two groups: 30 patients will be given 90 μg vitamin K2 + 10 μg and cholecalciferol 30 patients will be given only 10 μg cholecalciferol. After a 9-month treatment the image diagnostic will be carried out in order to estimate the degree of vessel calcification.

Study Overview

• Status: Unknown
• Conditions: Kidney Diseases; Coronary Artery Calcification
• Intervention / Treatment: Drug: Vitamin K2+10μg cholecalciferol; Drug: Vitamin D

Detailed Description

Vessel calcification is a recognised cardiovascular morbidity risk factor in patients with chronic kidney disease (CKD). Recent reports indicate a significant role of Matrix Gla-protein (MGP) in decreasing calcification processes. MGP is excretion protein whose mechanism of action is not yet fully explained and which to be activated requires phosphorylation and carboxylation where cofactor is vitamin K. Immunohistochemical tests showed a high level of un-carboxylated MGP in calcified vessels. These observations indicate that shortage of vitamin K is a significant risk factor for the development of vessel calcification. On the other hand CKD patients often display shortages of this vitamin. Another calcification risk factor in CKD patients are calcium-phosphate disturbances and insufficiency of vitamin D3 which in physiological concentration stimulates MGP transcription. Cranenburg et al. showed a decrease vessel calcification in dialysis patients treated with vitamin K2. Vitamin K2 exists in two forms K1 and K2, however only the K2 form displays calcification decreasing properties. There are currently no similar studies in patients with chronic kidney disease who do not require renal replacement therapy.

The aim of study. The aim of this study is estimation of influence of vitamin K2 administration over the period of 9 months on vessel calcification in 3.- 5. stage CKD patients.

Materials and methods. It is a prospective, randomised double-blind study carried out in parallel groups. 60 patients with CKD (GFR 15-60 ml/min) whose renal replacement therapy is to commence not earlier than in 9 months are planned to be qualified for the study. After familiarizing the patients with the aims of the study and obtaining their written consent, non-invasive tests will be carried out in order to estimate the presence and degree of vessel calcification: common carotid artery intima media thickness (CCA-IMT) by ultrasound examination, coronary artery calcium score (CACS) by multiscan CT as well as the presence of calcified heart valves by ultrasound examination. Patients with calcium score >10 (Agatston scoring system) will be qualified for the study. On the basis of randomised selection, patients will be divided into two groups: 30 patients will be given 90 μg vitamin K2+10 μg cholecalciferol (Vitamin D)and 30 patients will be given only 10 μg cholecalciferol. After a 9-month treatment the image diagnostic will be carried out in order to estimate the degree of vessel calcification. Patients and their basic laboratory test will be evaluated during the study period by a nephrologists on a monthly basis. First, at the commencement of the study, then after 3, 6 and finally after 9 months during the last visit, 10 ml of serum and plasma will be taken and frozen in order to conduct special marking tests: phosphorylated MGP (pMGP), uncarboxylated MGP (ucMGP), 25-OH cholecalciferol, hsCRP.

Scheduling Study Visits:

Visit 0 Screening Period

1. Review of inclusion and exclusion criteria
2. Obtain informed consent
3. Obtain weight and height
4. Obtain CACS, CCA-IMT
5. Obtain heart ultrasonography
6. Review concomitant therapy

Visit 1 - Randomization

1. Review of inclusion and exclusion criteria
2. Medical history for concomitant disorders (hypertension, heart ischemic diseases, diabetes mellitus)
3. Collect blood for serum chemistry (creatinine, albumin, intact PTH, calcium, phosphor, uric acid, lipids, glucose, kaolin-kephalin time, prothrombin index and blood morphology.
4. Collect blood for pMGP, ucMGP, 25-OH cholecalciferol, hsCRP
5. Review concomitant therapy
6. Randomization to: 90 μg vitamin K2+10μg cholecalciferol or 10μg cholecalciferol (Vitamin D) during 9 months

Visit 2,4,5,7,8 Visits every month

1. Complete physical examination
2. GFR obtain
3. Drug dispension

Visit 3,6 and after 9 months:

1. Complete physical examination
2. GFR obtain
3. Collect blood for serum chemistry (creatinine, albumin, intact PTH, calcium, phosphor, uric acid, lipids, glucose, kaolin-kephalin time, prothrombin index and blood morphology.
4. Collect blood for pMGP, ucMGP, 25-OH cholecalciferol, hsCRP
5. Obtain CACS, CCA-IMT
6. Obtain heart ultrasonography
7. Review concomitant therapy

• Study Type: Interventional
• Enrollment (Anticipated): 60
• Phase: Phase 4

Contacts and Locations

Study Locations

• Poland
  • Łódź, Poland, 90-153
    • Recruiting
    • Department of Nephrology, Hypertension and Kidney Transplantation
    • Contact: Michał Nowicki, Prof; Phone Number: 0048426776709; Email: nefro@wp.pl
    • Contact: Ilona Kurnatowska, MD; Phone Number: 0048509293095; Email: ilona.kurnatowska@umed.lodz.pl
    • Principal Investigator: Michał Nowicki, Prof

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 30 years to 70 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

1. Subject with chronic kidney disease (creatinine clearance 15-60 ml/min/1,73m2 by Cockroft-Gault formula)
2. Patient has a life without dialysis therapy of more than 9 months
3. Subject in 30-70 years of age
4. Calcium score >10 (as per Agatston scoring system)

Exclusion Criteria:

1. Atherosclerosis generalisata (myocardial infarction treated with PTCA - Percutaneous Transluminal Coronary Angioplasty or CABG - Coronary Artery Bypass Graft, symptomatic heart insufficiency, cerebrovascular accident)
2. Subject with a history of cardiac abnormalities, including symptomatic or asymptomatic arrhythmias (atrial fibrillation)
3. Patient with cardiac pacemaker
4. Subject requires long-term use of vitamin K antagonists

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Vitamin K2, calcification score changes, vitamin D; 90 μg vitamin K2+10μg cholecalciferol	Drug: Vitamin K2+10μg cholecalciferol; Pills of: 90 μg vitamin K2+10μg cholecalciferol once daily during 9 months; Drug: Vitamin D; Pills of: 10μg cholecalciferol (Vitamin D)once daily during 9 months
Active Comparator: Vitamin D, calcium score changes; 10μg cholecalciferol (vitamin D)	Drug: Vitamin K2+10μg cholecalciferol; Pills of: 90 μg vitamin K2+10μg cholecalciferol once daily during 9 months

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Changes in coronary artery calcification score	9 months

Secondary Outcome Measures

Outcome Measure	Time Frame
Changes in common carotid artery intima media thickness	9 months

Collaborators and Investigators

• Sponsor: Medical University of Lodz

Publications and helpful links

General Publications

• Schurgers LJ, Cranenburg EC, Vermeer C. Matrix Gla-protein: the calcification inhibitor in need of vitamin K. Thromb Haemost. 2008 Oct;100(4):593-603.
• Pilkey RM, Morton AR, Boffa MB, Noordhof C, Day AG, Su Y, Miller LM, Koschinsky ML, Booth SL. Subclinical vitamin K deficiency in hemodialysis patients. Am J Kidney Dis. 2007 Mar;49(3):432-9. doi: 10.1053/j.ajkd.2006.11.041.
• Cranenburg EC, Vermeer C, Koos R, Boumans ML, Hackeng TM, Bouwman FG, Kwaijtaal M, Brandenburg VM, Ketteler M, Schurgers LJ. The circulating inactive form of matrix Gla Protein (ucMGP) as a biomarker for cardiovascular calcification. J Vasc Res. 2008;45(5):427-36. doi: 10.1159/000124863. Epub 2008 Apr 10.
• Kurnatowska I, Grzelak P, Masajtis-Zagajewska A, Kaczmarska M, Stefanczyk L, Vermeer C, Maresz K, Nowicki M. Effect of vitamin K2 on progression of atherosclerosis and vascular calcification in nondialyzed patients with chronic kidney disease stages 3-5. Pol Arch Med Wewn. 2015;125(9):631-40. doi: 10.20452/pamw.3041. Epub 2015 Jul 15.

Study record dates

Study Major Dates

• Study Start: June 1, 2009
• Primary Completion (Anticipated): December 1, 2010
• Study Completion (Anticipated): June 1, 2011

Study Registration Dates

• First Submitted: April 9, 2010
• First Submitted That Met QC Criteria: April 9, 2010
• First Posted (Estimate): April 12, 2010

Study Record Updates

• Last Update Posted (Estimate): April 13, 2010
• Last Update Submitted That Met QC Criteria: April 12, 2010
• Last Verified: April 1, 2010

More Information

Terms related to this study

• Keywords: chronic kidney disease; intima media thickness; Vitamin K; coronary artery calcification
• Additional Relevant MeSH Terms: Metabolic Diseases; Urologic Diseases; Renal Insufficiency; Calcium Metabolism Disorders; Kidney Diseases; Renal Insufficiency, Chronic; Calcinosis; Physiological Effects of Drugs; Molecular Mechanisms of Pharmacological Action; Fibrin Modulating Agents; Micronutrients; Bone Density Conservation Agents; Calcium-Regulating Hormones and Agents; Antifibrinolytic Agents; Hemostatics; Coagulants; Vitamin D; Cholecalciferol; Vitamin K; Vitamins; Vitamin K 2
• Other Study ID Numbers: CACSK2