Vitamin K and D Supplementation and Bone Health in Chronic Kidney Disease—Apart or Together?

Abstract

Vitamin K (VK) and vitamin D (VD) deficiency/insufficiency is a common feature of chronic kidney disease (CKD), leading to impaired bone quality and a higher risk of fractures. CKD patients, with disturbances in VK and VD metabolism, do not have sufficient levels of these vitamins for maintaining normal bone formation and mineralization. So far, there has been no consensus on what serum VK and VD levels can be considered sufficient in this particular population. Moreover, there are no clear guidelines how supplementation of these vitamins should be carried out in the course of CKD. Based on the existing results of preclinical studies and clinical evidence, this review intends to discuss the effect of VK and VD on bone remodeling in CKD. Although the mechanisms of action and the effects of these vitamins on bone are distinct, we try to find evidence for synergy between them in relation to bone metabolism, to answer the question of whether combined supplementation of VK and VD will be more beneficial for bone health in the CKD population than administering each of these vitamins separately.

Low Vitamin K and Vitamin D Dietary Intake in Patients with Inflammatory Bowel Diseases

“…Iron deficit is actively sought after and treated with specific replacement regimens [ 56 ]. Vitamin K supplementation is advised in bone and inflammatory rheumatic disease, chronic renal failure and for the prevention of vascular calcification and cardiovascular disease [ 57 , 58 , 59 , 60 ]; however, is it hardly mentioned in the nutritional guidelines for IBD patients. This attitude should change in order to reduce the adjunctive risk factor of osteoporosis in already high-risk patients, prevent coagulation defects and possibly help modulate inflammatory responses in IBD.…”

Alkaline Phosphatase: An Old Friend as Treatment Target for Cardiovascular and Mineral Bone Disorders in Chronic Kidney Disease

“…Furthermore, ALP activity was increased significantly in human Caco-2 cells by MK-4 treatment, disclosing similar biochemical properties to the typical IALP [ 137 ]. Several observational and interventional studies have reported that CKD patients undergoing conservative or artificial renal replacement therapy (hemodialysis or PD) suffer from subclinical vitamin K deficiency, related to dietary regimen and overall poor nutrient intake [ 138 , 139 ]. The effect of vitamin K on bone strength mainly manifests through the vitamin K-dependent carboxylation and consequent activation of osteocalcin and MGP.…”

Vitamin D, respiratory infections, and chronic disease: Review of meta‐analyses and randomized clinical trials

“…A meta-analysis of 15 RCTs [93] and several other RCTs showed that vitamin D supplementation combined with calcium resulted in a statistically significant decreased risk of fractures among older women [94][95][96][97][98][99]. Also, meta-analysis of 47 RCTs encompassing 58,424 patients demonstrated that vitamin D with calcium supplement showed benefits in fracture reduction [100] and was effective in preventing bone fractures in several chronic diseases [101][102][103][104]. According to a review of RCTs, including residential care and community-dwelling elders, only a few trials demonstrated fracture risk reduction with vitamin D treatment [106], and several RCTs of vitamin D alone do not show any benefits for fracture reduction [105,[107][108][109][110][111]113].…”