关键词: 慢性肾疾病-矿物质和骨代谢异常, 维生素K₂, 血管钙化, 死亡终点事件

Abstract:

Objective To investigate the clinical significance of serum vitamin K₂ (VitK₂) detection in patients with stage 3-5 chronic kidney disease (CKD). Methods A total of 193 patients with stage 3-5 CKD who were hospitalized in the Department of Nephrology, Tianchang City People's Hospital from September 2020 to May 2023 were selected. According to the estimated glomerular filtration rate (eGFR) staging criteria, patients were divided into G3 stage group (n=30), G4 stage group (n=47) and G5 stage group (n=116). The differences of VitK₂ and its related indexes among the three groups were compared, and the independent risk factors of VitK₂ were explored by multivariate linear regression analysis. Then, patients were divided into low VitK₂ level group (n=95) and high VitK₂ level group (n=98) with the median of serum VitK₂ as the cut-off value. The differences of abdominal aortic calcification score (AACs), death endpoint events and related detection indexes between the two groups were analyzed. Binary logistic regression model was used to explore the effect of VitK₂ on the endpoint of death. Results There were no significant differences in gender and age among G3 group, G4 group and G5 group (P>0.05), but there was a significant difference in the proportion of primary diseases (P<0.05). The primary diseases in the G3 group were mainly chronic nephritis and hypertension and G4 group were mainly chronic nephritis and diabetes, and diabetes was the dominant primary disease in the G5 group. There were significant differences in VitK₂, homocysteine (Hcy), serum phosphorus, calcium-phosphorus product, intact parathyroid hormone (iPTH), interleukin 6 (IL-6), hemoglobin (HB), total cholesterol (TC), uric acid (UA) and AACs among the three groups (P<0.05). With the increase in clinical stage of CKD, VitK₂, eGFR and HB gradually decreased, while iPTH and AACs gradually increased. Multivariate linear regression analysis showed significantly influences of eGFR, AACs, TC and UA on VitK₂ (P<0.05). The AACs and the proportion achieving the endpoint (death) were significantly higher in the low VitK₂ group than the high VitK₂ group (P<0.05). Binary logistic regression analysis indicated that after adjusting for age, VitD₃, Hcy, eGFR and other covariates, the level of VitK₂ is an independent risk factor affecting the survival of CKD (P=0.001). Conclusion The detection of serum VitK₂ has certain clinical significant in predicting AACs, and the prognosis of CKD, which comprehensively evaluates condition in patients with stages 3-5 CKD.

Key words: chronic kidney disease-mineral and bone disorder, vitamin K₂, vascular calcification, death endpoint events