From the Guidelines
Vitamin K2 supplementation, particularly menaquinone-7 (MK-7), is recommended for patients undergoing hemodialysis due to its superior efficacy in promoting vascular health and reducing cardiovascular risk compared to Vitamin K1. The effects of Vitamin K1 and Vitamin K2 on patients undergoing Hemodialysis (HD) have been studied, with a focus on their role in vascular health and cardiovascular risk reduction.
Key Findings
- Vitamin K deficiency is common in hemodialysis patients, contributing to vascular calcification and increased cardiovascular risk 1.
- Vitamin K2, specifically menaquinone-7 (MK-7), has been shown to be more effective than Vitamin K1 in activating matrix Gla protein, which inhibits calcium deposition in vessel walls and potentially improves bone health 1.
- Supplementation with MK-7 at doses of 360-400 mcg daily has been commonly studied and is well-tolerated, while Vitamin K1 supplementation typically ranges from 500-1000 mcg daily.
Considerations for Supplementation
- Treatment duration in studies varies from 6 weeks to 12 months, with longer durations showing better outcomes for vascular calcification reduction.
- Patients should be aware that vitamin K supplements may interfere with warfarin therapy but not with direct oral anticoagulants.
- Monitoring calcium and phosphate levels during supplementation is advisable to minimize potential risks.
Recommendation
Based on the available evidence, Vitamin K2 supplementation is recommended for patients undergoing hemodialysis to promote vascular health and reduce cardiovascular risk. However, it is essential to consider individual patient needs and potential interactions with other medications, such as warfarin.
Additional Considerations
- The provided evidence 1 focuses on dietary reference intakes and supplementation guidelines for children with chronic kidney disease, but the principles of vitamin K supplementation can be applied to adult patients undergoing hemodialysis.
- Further research is needed to fully understand the effects of Vitamin K1 and Vitamin K2 on patients undergoing hemodialysis, but current evidence supports the use of Vitamin K2 supplementation to promote vascular health and reduce cardiovascular risk.
From the Research
Effects of Vitamin K1 and Vitamin K2 on Hemodialysis Patients
- Vitamin K1 and Vitamin K2 play a crucial role in regulating bone and vascular calcification in hemodialysis patients 2, 3, 4, 5, 6
- Low vitamin K concentrations are associated with increased risks of fractures and vascular calcification, which are common complications in hemodialysis patients 2, 4
- Vitamin K1 deficiency is a strong predictor of vertebral fractures, while Vitamin K2 (menaquinone-4) deficiency is a predictor of aortic calcification 2
- Vitamin K2 supplementation has been shown to reduce dephosphorylated-uncarboxylated matrix Gla protein (dp-ucMGP) levels, a marker of vascular calcification, in hemodialysis patients 3, 5, 6
- The optimal dose of Vitamin K2 for reducing dp-ucMGP levels is still being researched, with studies suggesting doses of 360-1080 μg thrice weekly 5 or 45-360 μg daily 6
Vitamin K Status in Hemodialysis Patients
- Hemodialysis patients often have low vitamin K intake and status, with high levels of non-carboxylated bone and coagulation proteins indicating subclinical hepatic vitamin K deficiency 4
- Vitamin K2 supplementation has been shown to improve the bioactivity of vitamin K-dependent proteins in hemodialysis patients, reducing circulating dephosphorylated-uncarboxylated MGP, uncarboxylated osteocalcin, and PIVKA-II levels 6