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The Vessels-Bone Axis: Iliac Artery Calcifications, Vertebral Fractures and Vitamin K from VIKI Study
Maria Fusaro1,2, Giovanni Tripepi3, Mario Plebani4
1National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy.
Insights
Iliac artery calcifications (IACs) increase vertebral fracture risk in hemodialysis patients. This association is linked to lower vitamin K2 levels, highlighting IACs as a significant risk factor for vertebral fractures.
Area of Science:
- Nephrology
- Vascular Biology
- Bone Metabolism
Background:
- Vascular calcification and fragility fractures are linked to poor outcomes, particularly in end-stage renal disease.
- Iliac artery calcifications (IACs) and abdominal aortic calcifications (AACs) are common in hemodialysis patients.
- The relationship between arterial calcification and vertebral fractures (VFs) in this population requires further investigation.
Purpose of the Study:
- To evaluate the association between IACs and AACs with the risk of VFs in hemodialysis patients.
- To explore the role of bone and vascular health markers, including vitamin K levels, in this relationship.
Main Methods:
- The VIKI study was a multicenter, cross-sectional study of 387 hemodialysis patients.
- Vertebral fractures (VFs), IACs, and AACs were assessed using standardized spine radiograms.
- Biochemical markers, including vitamin K, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate, were analyzed.
Main Results:
- The prevalence of IACs was 56.1% and AACs was 80.6%.
- After adjusting for confounders, IACs were associated with a 73% higher odds of VF (p = 0.028), while AACs showed no significant association (p = 0.294).
- Patients with IACs had lower levels of vitamin K2 and menaquinone 7, with this deficiency exacerbated after adjusting for triglycerides.
Conclusions:
- Iliac artery calcifications (IACs), irrespective of severity, represent a significant risk factor for vertebral fractures (VFs) in hemodialysis patients.
- The association between IACs and VFs is potentially influenced by vitamin K status.
- Further prospective studies are warranted to confirm these findings in chronic kidney disease and the general population.
Abstract:
Vascular calcification and fragility fractures are associated with high morbidity and mortality, especially in end-stage renal disease. We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aortic calcifications (AACs) with the risk for vertebral fractures (VFs) in hemodialysis patients. The VIKI study was a multicenter cross-sectional study involving 387 hemodialysis patients. The biochemical data included bone health markers, such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, and phosphate. VF, IACs and AACs was determined through standardized spine radiograms. VF was defined as >20% reduction of vertebral body height, and VC were quantified by measuring the length of calcium deposits along the arteries. The prevalence of IACs and AACs were 56.1% and 80.6%, respectively. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p = 0.028), whereas we found no association (p = 0.294) for AACs. IACs were associated with VF irrespective of calcification severity. Patients with IACs had lower levels of vitamin K2 and menaquinone 7 (0.99 vs. 1.15 ng/mL; p = 0.003), and this deficiency became greater with adjustment for triglycerides (0.57 vs. 0.87 ng/mL; p < 0.001). IACs, regardless of their extent, are a clinically relevant risk factor for VFs. The association is enhanced by adjusting for vitamin K, a main player in bone and vascular health. To our knowledge these results are the first in the literature. Prospective studies are needed to confirm these findings both in chronic kidney disease and in the general population.
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