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Abstract：
Patients with chronic kidney disease (CKD) suffer from vitamin K deficiency and are at high risk of vascular calcification (VC) and premature death. We investigated the association of functional vitamin K deficiency with all-cause mortality and whether this association is modified by the presence of VC in CKD stage 5 (CKD G5). Plasma dephosphorylated-uncarboxylated matrix Gla-protein (dp-ucMGP), a circulating marker of functional vitamin K deficiency, and other laboratory and clinical data were determined in 493 CKD G5 patients. VC was assessed in subgroups by Agatston scoring of coronary artery calcium (CAC) and aortic valve calcium (AVC). Backward stepwise regression did not identify dp-ucMGP as an independent determinant of VC. During a median follow-up of 42 months, 93 patients died. Each one standard deviation increment in dp-ucMGP was associated with increased risk of all-cause mortality (sub-hazard ratio (sHR) 1.17; 95% confidence interval, 1.01-1.37) adjusted for age, sex, cardiovascular disease, diabetes, body mass index, inflammation, and dialysis treatment. The association remained significant when further adjusted for CAC and AVC in sub-analyses (sHR 1.22, 1.01-1.48 and 1.27, 1.01-1.60, respectively). In conclusion, functional vitamin K deficiency associates with increased mortality risk that is independent of the presence of VC in patients with CKD G5.
摘要：
慢性肾脏病（CKD）患者患有维生素K缺乏症，血管钙化（VC）和过早死亡的风险很高。我们调查了功能性维生素K缺乏与全因死亡率的关联，以及这种关联是否因CKD5期（CKDG5）中VC的存在而改变。血浆去磷酸化-未羧化基质Gla-蛋白(dp-ucMGP),功能性维生素K缺乏的循环标志物，在493例CKDG5患者中确定了其他实验室和临床数据。通过冠状动脉钙（CAC）和主动脉瓣钙（AVC）的Agatston评分评估亚组的VC。反向逐步回归未将dp-ucMGP确定为VC的独立决定因素。在42个月的中位随访中，93例患者死亡。dp-ucMGP的每一个标准偏差增量与全因死亡率的风险增加相关(亚风险比(sHR)1.17;95%置信区间,1.01-1.37)根据年龄调整，性别,心血管疾病,糖尿病,身体质量指数,炎症,和透析治疗。当进一步调整子分析中的CAC和AVC时，相关性仍然显著（分别为sHR1.22、1.01-1.48和1.27、1.01-1.60）。总之,功能性维生素K缺乏与CKDG5患者死亡风险增加相关,这与VC的存在无关.
