title: Low vitamin K1 intake in haemodialysis patients.
abstract: Vitamin K acts as a coenzyme in the γ-carboxylation of vitamin K-dependent proteins, including coagulation factors, osteocalcin, matrix Gla protein (MGP), and the growth arrest-specific 6 (GAS6) protein. Osteocalcin is a key factor for bone matrix formation. MGP is a local inhibitor of soft tissue calcification. GAS6 activity prevents the apoptosis of vascular smooth muscle cells. Few data on vitamin K intake in chronic kidney disease patients and no data in patients on a Mediterranean diet are available. In the present study, we evaluate the dietary intake of vitamin K1 in a cohort of patients undergoing haemodialysis.
  
  
  
  In this multi-centre controlled observational study, data were collected from 91 patients aged >18 years on dialysis treatment for at least 12 months and from 85 age-matched control subjects with normal renal function. Participants completed a food journal of seven consecutive days for the estimation of dietary intakes of macro- and micro-nutrients (minerals and vitamins).
  
  
  
  Compared to controls, dialysis patients had a significant lower total energy intake, along with a lower dietary intake of proteins, fats, carbohydrates, fibres, and of all the examined minerals (Ca, P, Fe, Na, K, Zn, Cu, and Mg). With the exception of vitamin B12, vitamins intake followed a similar pattern, with a lower intake in vitamin A, B1, B2, C, D, E, folates, K1 and PP. These finding were confirmed also when normalized for total energy intake or for body weight. In respect to the adequate intakes recommended in the literature, the prevalence of a deficient vitamin K intake was very high (70-90%) and roughly double than in controls. Multivariate logistic model identified vitamin A and iron intake as predictors of vitamin K deficiency.
  
  
  
  Haemodialysis patients had a significantly low intake in vitamin K1, which could contribute to increase the risk of bone fractures and vascular calcifications. Since the deficiency of vitamin K intake seems to be remarkable, dietary counselling to HD patients should also address the adequacy of vitamin K dietary intake and bioavailability. Whether diets with higher amounts of vitamin K1 or vitamin K supplementation can improve clinical outcomes in dialysis patients remains to be demonstrated.
authors.affiliation: National Research Council (CNR) - Institute of Clinical Physiology (IFC), Pisa, Italy; Department of Medicine, University of Padua, Italy. Electronic address: dante.lucia@libero.it.
authors.forename: Maria
authors.initials: M
authors.lastname: Fusaro
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Claudia
authors.initials: C
authors.lastname: D'Alessandro
authors.affiliation: National Research Council (CNR), Neuroscience Institute, Padua, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Noale
authors.affiliation: Clinical Epidemiology and Physiopathology of Renal Diseases and Hypertension, CNR, Institute of Biomedicine, Reggio Calabria, Calabria, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tripepi
authors.affiliation: Laboratory Medicine Unit, Department of Medicine, University of Padua, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Plebani
authors.affiliation: Department of Medicine (DI-MED), Geriatric Section, University of Padua, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Veronese
authors.affiliation: National Research Council (CNR) - Institute of Clinical Physiology (IFC), Pisa, Italy; Department of Medicine, University of Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Iervasi
authors.affiliation: Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Giannini
authors.affiliation: Rheumatology Unit, Department of Medicine, University of Verona, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossini
authors.affiliation: Nephrology Unit, ULSS 1 Belluno, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Tarroni
authors.affiliation: UOC Nephrology and Dialysis, ULSS 13, Dolo, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Lucatello
authors.affiliation: UOC Nephrology and Dialysis, ULSS 2, Feltre, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Vianello
authors.affiliation: Nephrology Unit, University of Padua, Padua, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Santinello
authors.affiliation: Renal Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Luciana
authors.initials: L
authors.lastname: Bonfante
authors.affiliation: Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Fabris
authors.affiliation: Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Sella
authors.affiliation: Nephrology Unit, University of Padua, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Piccoli
authors.affiliation: Nephrology Unit, University of Padua, Padua, Italy.
authors.forename: Agostino
authors.initials: A
authors.lastname: Naso
authors.affiliation: Renal Unit, IRCCS Multimedica, Sesto San Giovanni, Milan, Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Ciurlino
authors.affiliation: Department of Medicine, Clinica Medica 1, University of Padova, Padova, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Aghi
authors.affiliation: Nephrology and Dialysis Unit, Ospedale San Carlo Borromeo, ASST Santi Paolo e Carlo, Milan, Italy; Department of Clinical and Biomedical Sciences "Luigi Sacco", University of Milano, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Gallieni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Adamasco
authors.initials: A
authors.lastname: Cupisti
mesh_terms: D000368:Aged; D015992:Body Mass Index; D016022:Case-Control Studies; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D018977:Micronutrients / Q000008:administration & dosage; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D064167:Recommended Dietary Allowances; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000097:blood* / Q000188:drug therapy; D012189:Retrospective Studies; D010837:Vitamin K 1 / Q000008:administration & dosage* / Q000097:blood; D014813:Vitamin K Deficiency / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy; D055105:Waist Circumference
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins; D018977:Micronutrients; D010837:Vitamin K 1
keywords: Dialysis; Diet; Haemodialysis; Menaquinone; Nutrition; Phylloquinone