Treatment of Vitamin K Deficiency in Hemodialysis Patients – A Pilot Study Comparing Menaquinone-7 Tablets and a Vitamin K Rich Diet

Abstract

Katrine Aagaard Lentz,1 Julie Vahlgren,2 Ditte Hansen,2,3 Mario Plebani,4 Maria Fusaro,4,5 Lars Melholt Rasmussen,6 Jette Jakobsen,7 Jens Jørgen Sloth,7 Henrik Post Hansen,3 Jens Rikardt Andersen1 1Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark; 2Department of Nephrology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark; 3Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; 4Department of Medicine, University of Padova, Padova, Italy; 5National Research Council, Institute of Clinical Physiology, Pisa, Italy; 6Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; 7National Food Institute, Technical University of Denmark, Lyngby, DenmarkCorrespondence: Ditte Hansen, Email [email protected]: Vitamin K deficiency and hence a high level of plasma dephosphorylated undercarboxylated matrix Gla protein (dp-ucMGP) is frequent in patients on hemodialysis. This group is recommended to restrict their potassium intake which often leads to restriction of vitamin K rich foods. A menaquinone-7 (MK-7) supplement has been shown to decrease dp-ucMGP, but it has yet to be examined if a vitamin K rich diet could be equally effective.Patients and Methods: A prospective randomized crossover intervention trial with two arms; 6 weeks of 360 μg MK-7 tablet/day and 6 weeks of a vitamin K rich diet with a 3-week washout period in between. Participants were 10 patients in hemodialysis and the primary outcome measures were changes in dp-ucMGP, total MGP (tMGP), and undercarboxylated osteocalcin (ucOC). Furthermore, the level of potassium and phylloquinone in broccoli was determined after different durations of boiling.Results: During the MK-7 intervention the dp-ucMGP and ucOC decreased significantly compared to baseline (− 0.42 [− 0.93; − 0.22] nmol/L (p=< 0.01) and − 1.85 [− 2.91; − 1.30] nmol/L (p< 0.01)), while these were unchanged during the dietary intervention (0.03 [− 0.64; 0.37] nmol/L (p=1.00) and 0.30 [− 1.71; 1.41] nmol/L (p=0.77)). Between the two interventions there was a greater decrease in ucOC (p=0.02) during the MK-7 compared to the dietary period. No significant changes in the total MGP levels were found in any of the periods. The retention of potassium following boiling for 2 minutes and 8 minutes was 76% and 49%, respectively, while for phylloquinone the retention was 92%, and independent of duration of boiling.Conclusion: A daily MK-7 supplement for 6 weeks lowered dp-ucMGP and ucOC significantly, while a vitamin K rich diet was not able to induce any significant effect. Boiled broccoli maintains a reasonable content of phylloquinone while potassium is extracted and is a reasonable source of phylloquinone for patients on hemodialysis.Keywords: hemodialysis, phylloquinone, menaquinone, nutrition

Keywords

• hemodialysis
• phylloquinone
• menaquinone
• nutrition