Clinical significance of serum vitamin K2 detection in patients with stage 3-5 chronic kidney disease

doi:10.3969/j.issn.1004-583X.2025.02.004

Abstract

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

CLC Number:

R681.1

Chen Tianhao, Huang Zheng. Clinical significance of serum vitamin K₂ detection in patients with stage 3-5 chronic kidney disease[J]. Clinical Focus, 2025, 40(2): 122-127.

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Figures/Tables 6

References 15

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组别	例数	性别[例(%)]		年龄(岁)	原发病[例(%)]
组别	例数	男	女	年龄(岁)	慢性肾炎	糖尿病	高血压	其他
G3期组	30	21(70.00)	9(30.00)	62.07±14.43	12(40.00)	4(13.33)	12(40.00)	2(6.67)
G4期组	47	29(61.71)	18(38.29)	60.47±14.49	17(36.17)	17(36.17)	8(17.02)	5(10.64)
G5期组	116	65(56.03)	51(43.97)	64.60±13.39	27(23.28)	48(41.38)	26(22.41)	15(12.93)
F/χ²值		2.051		1.471	12.546
P值		0.361		0.233	0.044

组别	例数	性别[例(%)]		年龄(岁)	原发病[例(%)]
组别	例数	男	女	年龄(岁)	慢性肾炎	糖尿病	高血压	其他
G3期组	30	21(70.00)	9(30.00)	62.07±14.43	12(40.00)	4(13.33)	12(40.00)	2(6.67)
G4期组	47	29(61.71)	18(38.29)	60.47±14.49	17(36.17)	17(36.17)	8(17.02)	5(10.64)
G5期组	116	65(56.03)	51(43.97)	64.60±13.39	27(23.28)	48(41.38)	26(22.41)	15(12.93)
F/χ²值		2.051		1.471	12.546
P值		0.361		0.233	0.044

组别		例数	VitK₂ (μg/L)			25(OH)VitD₃ (μg/L)			HCY (μmol/L)		校正血钙 (mmol/L)			血磷 (mmol/L)		钙磷乘积
G3期组		30	0.125(0.080, 0.180)			15.901(11.120, 24.021)			15.357±4.871		2.311±0.210			1.141±0.212		2.752(2.323,3.056)
G4期组		47	0.100(0.060, 0.170)^*			19.201(11.582, 26.5100)			20.985±9.921		2.380±0.42			1.151±0.261		2.632(2.271, 2.931)
G5期组		116	0.090(0.050, 0.160)^*#			15.640(11.300, 23.100)			28.003±19.112^*#		2.291±0.162			1.701±0.562^*#		3.762(3.081, 4.354)^*#
F/Z值			6.856			1.721			8.891		2.211			32.862		57.142
P值			0.031			0.422			<0.001		0.123			<0.001		<0.001
组别	iPTH(ng/L)			CRP(mg/L)			IL-6(ng/L)			ALB(g/L)			ALP(IU/L)			HB(g/L)
G3期组	58.950(39.270, 80.130)			4.550(2.98, 8.570)			6.321(2.251,18.544)			36.950(33.625, 41.000)			83.500(70.750, 96.780)			120.570(105.250, 138.150)
G4期组	97.861(58.448, 141.073)^*			4.052(2.825, 10.035)			11.132(5.811, 60.295)			35.810(32.425, 38.775)			82.510(74.550, 104.115)			103.000(93.510, 115.110)^*
G5期组	195.122(101.81, 348.460)^*#			7.610(3.450, 16.850)			13.692(6.555, 30.776)^*#			35.352(32.550, 37.250)			86.340(66.680, 116.550)			94.000(78.500, 102.100)^*#
F/Z值	52.492			5.431			7.921			3.3404			0.725			47.150
P值	<0.001			0.066			0.015			0.185			0.695			<0.001
组别		TC(mmol/L)			LDL-C(mmol/L)			UA(μmol/L)				eGFR[ml/(min·1.73 m²)]			AACs
G3期组		4.850(3.645, 5.760)			2.855(2.470, 3.658)			380.600(321.600, 493.500)				41.279±6.525			1.801(0.015,4.001)
G4期组		4.290(3.638, 5.355)			2.850(2.158, 3.450)			425.000(330.100, 555.750)				21.331±3.971*			2.015(0.001, 8.010)^*
G5期组		3.920(3.560, 4.920)^*#			2.390(1.925, 3.255)			450.310(385.550, 524.950)^*#				7.409±3.443^*#			2.505(0.001,7.001)^*#
F/Z值		7.602			5.779			9.593				830.825			8.152
P值		0.021			0.055			0.015				<0.001			0.039

组别		例数	VitK₂ (μg/L)			25(OH)VitD₃ (μg/L)			HCY (μmol/L)		校正血钙 (mmol/L)			血磷 (mmol/L)		钙磷乘积
G3期组		30	0.125(0.080, 0.180)			15.901(11.120, 24.021)			15.357±4.871		2.311±0.210			1.141±0.212		2.752(2.323,3.056)
G4期组		47	0.100(0.060, 0.170)^*			19.201(11.582, 26.5100)			20.985±9.921		2.380±0.42			1.151±0.261		2.632(2.271, 2.931)
G5期组		116	0.090(0.050, 0.160)^*#			15.640(11.300, 23.100)			28.003±19.112^*#		2.291±0.162			1.701±0.562^*#		3.762(3.081, 4.354)^*#
F/Z值			6.856			1.721			8.891		2.211			32.862		57.142
P值			0.031			0.422			<0.001		0.123			<0.001		<0.001
组别	iPTH(ng/L)			CRP(mg/L)			IL-6(ng/L)			ALB(g/L)			ALP(IU/L)			HB(g/L)
G3期组	58.950(39.270, 80.130)			4.550(2.98, 8.570)			6.321(2.251,18.544)			36.950(33.625, 41.000)			83.500(70.750, 96.780)			120.570(105.250, 138.150)
G4期组	97.861(58.448, 141.073)^*			4.052(2.825, 10.035)			11.132(5.811, 60.295)			35.810(32.425, 38.775)			82.510(74.550, 104.115)			103.000(93.510, 115.110)^*
G5期组	195.122(101.81, 348.460)^*#			7.610(3.450, 16.850)			13.692(6.555, 30.776)^*#			35.352(32.550, 37.250)			86.340(66.680, 116.550)			94.000(78.500, 102.100)^*#
F/Z值	52.492			5.431			7.921			3.3404			0.725			47.150
P值	<0.001			0.066			0.015			0.185			0.695			<0.001
组别		TC(mmol/L)			LDL-C(mmol/L)			UA(μmol/L)				eGFR[ml/(min·1.73 m²)]			AACs
G3期组		4.850(3.645, 5.760)			2.855(2.470, 3.658)			380.600(321.600, 493.500)				41.279±6.525			1.801(0.015,4.001)
G4期组		4.290(3.638, 5.355)			2.850(2.158, 3.450)			425.000(330.100, 555.750)				21.331±3.971*			2.015(0.001, 8.010)^*
G5期组		3.920(3.560, 4.920)^*#			2.390(1.925, 3.255)			450.310(385.550, 524.950)^*#				7.409±3.443^*#			2.505(0.001,7.001)^*#
F/Z值		7.602			5.779			9.593				830.825			8.152
P值		0.021			0.055			0.015				<0.001			0.039

因素	b	β	SE	t值	P值
年龄	-0.091	-0.001	0.002	-0.820	0.391
性别	0.061	0.061	0.045	1.458	0.163
25(OH)VitD₃	-0.113	-0.001	0.002	-0.661	0.557
iPTH	0.081	0.001	0.000	0.351	0.726
HCY	0.042	0.000	0.002	-0.254	0.838
CRP	0.067	0.001	0.001	0.655	0.533
IL-6	-0.096	-0.001	0.000	-1.351	0.185
ALB	0.006	0.112	0.103	0.944	0.322
校正血钙	0.056	0.076	0.109	0.584	0.560
血磷	-0.071	-0.041	0.030	-1.335	0.171
钙磷乘积	-0.058	-0.021	0.013	-1.121	0.256
ALP	-0.084	0.000	0.000	-0.026	0.981
HB	-0.087	0.001	0.001	1.154	0.252
TC	0.115	0.050	0.015	3.365	0.001
LDL-C	-0.177	0.037	0.021	1.765	0.078
UA	0.232	0.001	0.000	1.590	0.022
eGFR	0.097	0.003	0.002	2.557	0.041
AACs	-0.097	-0.011	0.001	2.005	0.047

Clinical significance of serum vitamin K₂ detection in patients with stage 3-5 chronic kidney disease

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组别		例数	25(OH)VitD₃ (μg/L)		HCY (μmol/L)		校正血钙 (mmol/L)		血磷 (mmol/L)	iPTH (ng/L)	CRP (mg/L)		IL-6 (ng/L)		ALB (g/L)
低水平VitK₂组		95	18.565±10.664		25.868±17.760		2.301±0.204		1.476±0.471	148.000 (71.485, 296.678)	6.500 (3.100, 16.000)		16.780 (7.015, 63.000)		35.771±5.012
高水平VitK₂组		98	18.022±8.666		22.934±15.048		2.327±0.202		1.482±0.585	101.560 (71.130, 251.360)	5.000 (3.025, 10.000)		8.735 (4.083, 21.440)		35.862±5.194
t/Z/χ²值			0.389		1.231		-0.869		-0.081	-1.348	-1.196		-2.516		-0.125
P值			0.698		0.225		0.386		0.935	0.178	0.232		0.012		0.901
组别	ALP (IU/L)			HB (g/L)		TC (mmol/L)		LDL-C (mmol/L)		UA (μmol/L)		eGFR [ml/(min·1.73 m²)]		AACs		终点死亡 [例(%)]
低水平VitK₂组	84.000 (71.000, 116.000)			100.734±23.092		4.183±1.196		2.584±0.918		387.000 (330.500, 493.500)		15.005±12.244		4.015 (0.005, 9.015)		20(21.05)
高水平VitK₂组	83.000 (68.000, 108.000)			97.633±21.212		4.496±1.521		2.800±1.104		443.500 (352.750, 519.750)		17.090±13.656		1.015 (0.051, 4.055)		3(3.16)
t/Z /χ²值	-0.811			0.970		-1.585		-1.473		-2.433		-1.116		4.215		15.715
P值	0.418			0.333		0.115		0.142		0.035		0.266		0.008		0.001

因素	回归系数	标准误	Wald χ²值	P值	OR值	95%CI
因素	回归系数	标准误	Wald χ²值	P值	OR值	下限	上限
VitK₂(高vs低)	2.612	0.756	3.455	0.001	13.622	3.096	59.940
年龄	-3.630	0.172	-2.107	0.035	0.696	0.497	0.975
25(OH)ViD₃	0.656	0.326	2.014	0.044	1.927	1.018	3.648
HCY	-0.123	0.059	-2.066	0.039	0.884	0.787	0.994
eGFR	0.889	0.426	2.086	0.037	2.432	1.055	5.607

[1]	Liu Shenghua. Correlation between serum uric acid levels and coronary artery calcification severity in patients with stable angina pectoris [J]. Clinical Focus, 2025, 40(3): 211-216.
[2]	Zheng Lihua, Du Runsen, Zhao Yaheng, Liu Peng. Influencing factors and predictive indicators of vascular calcification [J]. Clinical Focus, 2022, 37(2): 114-118.
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[4]	Zhou Fanli1， Lu Lan1， Fang Xian1， Long Kai1， Mao Yanqing2， Wu Chunxia1. Characteristics and influencing factors of vascular calcification in maintenance hemodialysis patients [J]. Clinical Focus, 2017, 32(10): 858-860.

因素	b	β	SE	t值	P值
年龄	-0.021	0.000	0.002	0.023	0.985
性别	0.045	0.055	0.065	0.745	0.447
25(OH)VitD₃	-1.231	0.000	0.003	0.053	0.958
iPTH	0.055	0.000	0.000	1.228	0.255
HCY	0.046	0.001	0.002	0.554	0.600
CRP	0.006	0.000	0.001	0.334	0.739
IL-6	0.125	0.000	0.000	-1.081	0.283
ALB	-0.007	-0.005	0.019	-0.271	0.878
校正血钙	0.164	0.009	1.105	0.008	0.994
血磷	-0.247	-0.112	0.251	-0.422	0.674
钙磷乘积	0.282	0.035	0.115	0.332	0.740
ALP	0.066	0.000	0.000	-0.469	0.651
HB	-0.061	-0.002	0.002	-1.235	0.221
TC	0.281	0.076	0.073	1.035	0.041
LDL-C	-0.193	-0.055	0.099	-0.670	0.505
UA	0.162	0.002	0.000	2.885	0.007
eGFR	0.235	0.006	0.003	1.982	0.025
AACs	-0.053	-0.002	0.001	1.565	0.015

因素	b	β	SE	t值	P值
年龄	-0.021	0.000	0.002	0.023	0.985
性别	0.045	0.055	0.065	0.745	0.447
25(OH)VitD₃	-1.231	0.000	0.003	0.053	0.958
iPTH	0.055	0.000	0.000	1.228	0.255
HCY	0.046	0.001	0.002	0.554	0.600
CRP	0.006	0.000	0.001	0.334	0.739
IL-6	0.125	0.000	0.000	-1.081	0.283
ALB	-0.007	-0.005	0.019	-0.271	0.878
校正血钙	0.164	0.009	1.105	0.008	0.994
血磷	-0.247	-0.112	0.251	-0.422	0.674
钙磷乘积	0.282	0.035	0.115	0.332	0.740
ALP	0.066	0.000	0.000	-0.469	0.651
HB	-0.061	-0.002	0.002	-1.235	0.221
TC	0.281	0.076	0.073	1.035	0.041
LDL-C	-0.193	-0.055	0.099	-0.670	0.505
UA	0.162	0.002	0.000	2.885	0.007
eGFR	0.235	0.006	0.003	1.982	0.025
AACs	-0.053	-0.002	0.001	1.565	0.015