본문 바로가기
KERD
논문KCI 등재

Supplementary nutrients for prevention of vascular calcification in patients with chronic kidney disease

2

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류내과학

초록

Vascular calcification (VC) and malnutrition associated with cardiovascular disease are common in patients with chronic kidney disease (CKD) treated with dialysis. VC, which reflects vascular aging, and malnutrition are also encountered in the non-CKD elderly population. This similarity of clinical findings suggests that the progression of CKD is related to aging and the existence of a causal relationship between VC and malnutrition. To retard renal progression, a low‑ or very‑low‑protein diet is usually recommended for CKD patients. Dietary education may induce malnutrition and deficiency of important nutrients, such as vitamins K and D. Menaquinone-7, a type of vitamin K2, is under investigation for inhibiting VC in elderly patients without CKD, as well as for prevention of VC in patients with CKD. Nutritional vitamin D, such as cholecalciferol, may be considered to decrease the required dose of active vitamin D, which increases the risk of VC due to increased calcium and phosphate loads. Omega-3 fatty acids are important nutrients and their ability to inhibit VC needs to be evaluated in clinical trials. This review focuses on the ability of supplementary nutrients to prevent VC in patients with CKD, in whom dietary restriction is essential.

Abstract

Vascular calcification (VC) and malnutrition associated with cardiovascular disease are common in patients with chronic kidney disease (CKD) treated with dialysis. VC, which reflects vascular aging, and malnutrition are also encountered in the non-CKD elderly population. This similarity of clinical findings suggests that the progression of CKD is related to aging and the existence of a causal relationship between VC and malnutrition. To retard renal progression, a low‑ or very‑low‑protein diet is usually recommended for CKD patients. Dietary education may induce malnutrition and deficiency of important nutrients, such as vitamins K and D. Menaquinone-7, a type of vitamin K2, is under investigation for inhibiting VC in elderly patients without CKD, as well as for prevention of VC in patients with CKD. Nutritional vitamin D, such as cholecalciferol, may be considered to decrease the required dose of active vitamin D, which increases the risk of VC due to increased calcium and phosphate loads. Omega-3 fatty acids are important nutrients and their ability to inhibit VC needs to be evaluated in clinical trials. This review focuses on the ability of supplementary nutrients to prevent VC in patients with CKD, in whom dietary restriction is essential.

참고문헌 (104)

  1. Foley RN, "Clinical epidemiology of cardiovascular disease in chronic renal disease", Am J Kidney Dis, 32(5 Suppl 3), pp.S112~S119 (1998)
  2. 진동찬, "Current characteristics of dialysis therapy in Korea: 2016 registry data focusing on diabetic patients", Kidney Research and Clinical Practice, 37(1), pp.20~29 (2018), 대한신장학회
  3. 이미정, "Changes in geriatric nutritional risk index and risk of major adverse cardiac and cerebrovascular events in incident peritoneal dialysis patients", Kidney Research and Clinical Practice, 36(4), pp.377~386 (2017), 대한신장학회
  4. Russo D, "Coronary artery calcification in patients with CRF not undergoing dialysis", Am J Kidney Dis, 44, pp.1024~1030 (2004)
  5. Fox CS, "Kidney function is inversely associated with coronary artery calcification in men and women free of cardiovascular disease : the Framingham Heart Study", Kidney Int, 66, pp.2017~2021 (2004)
  6. Honkanen E, "Abdominal aortic calcification in dialysis patients : results of the CORD study", Nephrol Dial Transplant, 23, pp.4009~4015 (2008)
  7. Verbeke F, "Prognostic value of aortic stiffness and calcification for cardiovascular events and mortality in dialysis patients : outcome of the calcification outcome in renal disease(CORD)study", Clin J Am Soc Nephrol, 6, pp.153~159 (2011)
  8. Adragao T, "A simple vascular calcification score predicts cardiovascular risk in haemodialysis patients", Nephrol Dial Transplant, 19, pp.1480~1488 (2004)
  9. 안원석, "Associations between Oxidized LDL to LDL Ratio, HDL and Vascular Calcification in the Feet of Hemodialysis Patients", Journal of Korean Medical Science, 24, pp.115~120 (2009), 대한의학회
  10. An WS, "Vascular calcification score on plain radiographs of the feet as a predictor of peripheral arterial disease in patients with chronic kidney disease", Int Urol Nephrol, 42, pp.773~780 (2010)
  11. Ogawa T, "Simple evaluation of aortic arch calcification by chest radiography in hemodialysis patients", Hemodial Int, 13, pp.301~306 (2009)
  12. Nitta K, "Aortic arch calcification and clinical outcome in patients with end-stage renal disease", Tohoku J Exp Med, 223, pp.79~84 (2011)
  13. 김선철, "Relationship between pulmonary hypertension, peripheral vascular calcification, and major cardiovascular events in dialysis patients", Kidney Research and Clinical Practice, 34(1), pp.28~34 (2015), 대한신장학회
  14. Adragao T, "A plain X-ray vascular calcification score is associated with arterial stiffness and mortality in dialysis patients", Nephrol Dial Transplant, 24, pp.997~1002 (2009)
  15. Lee SM, "Abdominal aortic calcification score among several vascular calcification scores of plain radiograph is the most reliable predictor of severe coronary artery calcification in dialysis patients", Ren Fail, 39, pp.729~735 (2017)
  16. Russo D, "Pulse pressure and presence of coronary artery calcification", Clin J Am Soc Nephrol, 4, pp.316~322 (2009)
  17. Kidney Disease: Improving Global Outcomes (KDIGO)CKD-MBD Update Work Group, "KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)", Kidney Int Suppl (2011), 7, pp.1~59 (2017)
  18. An WS, "Vascular calcification on plain radiographs is associated with carotid intima media thickness, malnutrition and cardiovascular events in dialysis patients : a prospective observational study", BMC Nephrol, 14, pp.27~ (2013)
  19. Noordzij M, "Progression of aortic calcification is associated with disorders of mineral metabolism and mortality in chronic dialysis patients", Nephrol Dial Transplant, 26, pp.1662~1669 (2011)
  20. Amann K, "Media calcification and intima calcification are distinct entities in chronic kidney disease", Clin J Am Soc Nephrol, 3, pp.1599~1605 (2008)
  21. 이자영, "Pre-existing arterial pathologic changes affecting arteriovenous fistula patency and cardiovascular mortality in hemodialysis patients", The Korean Journal of Internal Medicine, 32(5), pp.790~797 (2017), 대한내과학회[DOI]
  22. Shanahan CM, "Medial localization of mineralization-regulating proteins in association with Monckeberg’s sclerosis : evidence for smooth muscle cell-mediated vascular calcification", Circulation, 100, pp.2168~2176 (1999)
  23. London GM, "Arterial media calcification in end-stage renal disease : impact on all-cause and cardiovascular mortality", Nephrol Dial Transplant, 18, pp.1731~1740 (2003)
  24. Keelan PC, "Long-term prognostic value of coronary calcification detected by electron-beam computed tomography in patients undergoing coronary angiography", Circulation, 104, pp.412~417 (2001)
  25. Guerin AP, "Arterial stiffening and vascular calcifications in end-stage renal disease", Nephrol Dial Transplant, 15, pp.1014~1021 (2000)
  26. Hayden MR, "Vascular ossification-calcification in metabolic syndrome, type 2 diabetes mellitus, chronic kidney disease, and calciphylaxis-calcific uremic arteriolopathy : the emerging role of sodium thiosulfate", Cardiovasc Diabetol, 4, pp.4~ (2005)
  27. Tonelli M, "Relation between serum phosphate level and cardiovascular event rate in people with coronary disease", Circulation, 112, pp.2627~2633 (2005)
  28. Kestenbaum B, "Serum phosphate levels and mortality risk among people with chronic kidney disease", J Am Soc Nephrol, 16, pp.520~528 (2005)
  29. Hruska KA, "Renal osteodystrophy, phosphate homeostasis, and vascular calcification", Semin Dial, 20, pp.309~315 (2007)
  30. Kovesdy CP, "Serum phosphorus and the risk of progression of chronic kidney disease", Nephrol Dial Transplant, 22, pp.3679~3680 (2007)
  31. Barril-Cuadrado G, "Table showing dietary phosphorus", protein ratio for the Spanish population. Usefulness in chronic kidney disease, 2013, pp.33, 362~371
  32. 황은아, "Management of chronic kidney disease–mineral and bone disorder: Korean working group recommendations", Kidney Research and Clinical Practice, 34(1), pp.4~12 (2015), 대한신장학회
  33. Block GA, "Mortality effect of coronary calcification and phosphate binder choice in incident hemodialysis patients", Kidney Int, 71, pp.438~441 (2007)
  34. Chertow GM, "Determinants of progressive vascular calcification in haemodialysis patients", Nephrol Dial Transplant, 19, pp.1489~1496 (2004)
  35. Ok E, "Reduction of dialysate calcium level reduces progression of coronary artery calcification and improves low bone turnover in patients on hemodialysis", J Am Soc Nephrol, 27, pp.2475~2486 (2016)
  36. Jwa-Kyung Kim, "Effects of Lowering Dialysate Calcium Concentrations on Arterial Stiffness in Patients Undergoing Hemodialysis", The Korean Journal of Internal Medicine, 26(3), pp.320~327 (2011), 대한내과학회
  37. Kim SJ, "Effects of low calcium dialysate on the progression of coronary artery calcification in hemodialysis patients : an open-label 12-month randomized clinical trial", Int J Cardiol, 243, pp.431~436 (2017)
  38. Kidney Disease : Improving Global Outcomes(KDIGO)CKD Work Group, "KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease", Kidney Int Suppl, 3, pp.1~150 (2013)
  39. Shinaberger CS, "Longitudinal associations between dietary protein intake and survival in hemodialysis patients", Am J Kidney Dis, 48, pp.37~49 (2006)
  40. Kalantar-Zadeh K, "Malnutrition-inflammation complex syndrome in dialysis patients : causes and consequences", Am J Kidney Dis, 42, pp.864~881 (2003)
  41. Price PA, "Artery calcification in uremic rats is increased by a low protein diet and prevented by treatment with ibandronate", Kidney Int, 70, pp.1577~1583 (2006)
  42. Mirey Karavetian, "Patient education for hyperphosphatemia management: Improving outcomes while decreasing costs?", Kidney Research and Clinical Practice, 37(1), pp.4~7 (2018), 대한신장학회
  43. 임은수, "Effects of education on low-phosphate diet and phosphate binder intake to control serum phosphate among maintenance hemodialysis patients: A randomized controlled trial", Kidney Research and Clinical Practice, 37(1), pp.69~76 (2018), 대한신장학회
  44. Garneata L, "Ketoanalogue-supplemented vegetarian very low-protein diet and CKD progression", J Am Soc Nephrol, 27, pp.2164~2176 (2016)
  45. Bancha Satirapoj, "Very low protein diet plus ketoacid analogs of essential amino acids supplement to retard chronic kidney disease progression", Kidney Research and Clinical Practice, 37(4), pp.384~392 (2018), 대한신장학회
  46. Helvig CF, "Dysregulation of renal vitamin D metabolism in the uremic rat", Kidney Int, 78, pp.463~472 (2010)
  47. Kidney Disease: Improving Global Outcomes (KDIGO)CKD-MBD Work Group, "KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD)", Kidney Int Suppl, 76(Suppl 113), pp.S1~S130 (2009)
  48. Shoben AB, "Association of oral calcitriol with improved survival in nondialyzed CKD", J Am Soc Nephrol, 19, pp.1613~1619 (2008)
  49. Kovesdy CP, "Association of activated vitamin D treatment and mortality in chronic kidney disease", Arch Intern Med, 168, pp.397~403 (2008)
  50. Henley C, "1, 25-Dihydroxyvitamin D3 but not cinacalcet HCl(Sensipar", Mimpara)treatment mediates aortic calcification in a rat model of secondary hyperparathyroidism, 2005, pp.20, 1370~1377
  51. Hirata M, "In subtotally nephrectomized rats 22-oxacalcitriol suppresses parathyroid hormone with less risk of cardiovascular calcification or deterioration of residual renal function than 1, 25(OH)2 vitamin D3", Nephrol Dial Transplant, 18, pp.1770~1776 (2003)
  52. Tukaj C, "Morphological changes of aortal smooth muscle cells exposed to calcitriol in culture", Med Sci Monit, 6, pp.668~674 (2000)
  53. Wetmore JB, "A randomized trial of cinacalcet versus vitamin D analogs as monotherapy in secondary hyperparathyroidism(PARADIGM)", Clin J Am Soc Nephrol, 10, pp.1031~1040 (2015)
  54. Mizobuchi M, "Differential effects of vitamin D receptor activators on vascular calcification in uremic rats", Kidney Int, 72, pp.709~715 (2007)
  55. Wu-Wong JR, "Role of phosphorus and vitamin D analogs in the pathogenesis of vascular calcification", J Pharmacol Exp Ther, 318, pp.90~98 (2006)
  56. Raggi P, "The ADVANCE study : a randomized study to evaluate the effects of cinacalcet plus low-dose vitamin D on vascular calcification in patients on hemodialysis", Nephrol Dial Transplant, 26, pp.1327~1339 (2011)
  57. Garcia-Lopes MG, "Cholecalciferol supplementation in chronic kidney disease : restoration of vitamin D status and impact on parathyroid hormone", Ann Nutr Metab, 61, pp.74~82 (2012)
  58. Dogan E, "Effect of depot oral cholecalciferol treatment on secondary hyperparathyroidism in stage 3 and stage 4 chronic kidney diseases patients", Ren Fail, 30, pp.407~410 (2008)
  59. Oksa A, "Effects of longterm cholecalciferol supplementation on mineral metabolism and calciotropic hormones in chronic kidney disease", Kidney Blood Press Res, 31, pp.322~329 (2008)
  60. Zheng JQ, "Cholecalciferol additively reduces serum parathyroid hormone and increases vitamin D and cathelicidin levels in paricalcitol-treated secondary hyperparathyroid hemodialysis patients", Nutrients, 8, pp.E708~ (2016)
  61. Matias PJ, "Cholecalciferol supplementation in hemodialysis patients : effects on mineral metabolism, inflammation, and cardiac dimension parameters", Clin J Am Soc Nephrol, 5, pp.905~911 (2010)
  62. Zheng CM, "Cholecalciferol additively reduces serum parathyroid hormone levels in severe secondary hyperparathyroidism treated with calcitriol and cinacalcet among hemodialysis patients", Nutrients, 10 (2018)
  63. Schurgers LJ, "Determination of phylloquinone and menaquinones in food. Effect of food matrix on circulating vitamin K concentrations", Haemostasis, 30, pp.298~307 (2000)
  64. Krueger T, "Vitamin K deficiency in CKD patients: a modifiable risk factor for vascular calcification?", Kidney Int, 76, pp.18~22 (2009)
  65. Binkley NC, "Vitamin K nutrition and osteoporosis", J Nutr, 125, pp.1812~1821 (1995)
  66. Feskanich D, "Vitamin K intake and hip fractures in women : a prospective study", Am J Clin Nutr, 69, pp.74~79 (1999)
  67. Geleijnse JM, "Dietary intake of menaquinone is associated with a reduced risk of coronary heart disease : the Rotterdam Study", J Nutr, 134, pp.3100~3105 (2004)
  68. Braam LA, "Beneficial effects of vitamins D and K on the elastic properties of the vessel wall in postmenopausal women : a follow-up study", Thromb Haemost, 91, pp.373~380 (2004)
  69. Cranenburg EC, "Vitamin K intake and status are low in hemodialysis patients", Kidney Int, 82, pp.605~610 (2012)
  70. Pilkey RM, "Subclinical vitamin K deficiency in hemodialysis patients", Am J Kidney Dis, 49, pp.432~439 (2007)
  71. Saifan C, "Warfarin-induced calciphylaxis : a case report and review of literature", Int J Gen Med, 6, pp.665~669 (2013)
  72. Mehta RL, "Skin necrosis associated with acquired protein C deficiency in patients with renal failure and calciphylaxis", Am J Med, 88, pp.252~257 (1990)
  73. Caluwe R, "Vitamin K2 supplementation in haemodialysis patients : a randomized dose-finding study", Nephrol Dial Transplant, 29, pp.1385~1390 (2014)
  74. Booth SL, "Associations between vitamin K biochemical measures and bone mineral density in men and women", J Clin Endocrinol Metab, 89, pp.4904~4909 (2004)
  75. Vergnaud P, "Undercarboxylated osteocalcin measured with a specific immunoassay predicts hip fracture in elderly women : the EPIDOS Study", J Clin Endocrinol Metab, 82, pp.719~724 (1997)
  76. Cranenburg EC, "The circulating inactive form of matrix Gla protein(ucMGP)as a biomarker for cardiovascular calcification", J Vasc Res, 45, pp.427~436 (2008)
  77. Cranenburg EC, "Characterisation and potential diagnostic value of circulating matrix Gla protein(MGP)species", Thromb Haemost, 104, pp.811~822 (2010)
  78. Booth SL, "Response of vitamin K status to different intakes and sources of phylloquinone-rich foods : comparison of younger and older adults", Am J Clin Nutr, 70, pp.368~377 (1999)
  79. Sokoll LJ, "Changes in serum osteocalcin, plasma phylloquinone, and urinary gamma-carboxyglutamic acid in response to altered intakes of dietary phylloquinone in human subjects", Am J Clin Nutr, 65, pp.779~784 (1997)
  80. Westenfeld R, "Effect of vitamin K2 supplementation on functional vitamin K deficiency in hemodialysis patients : a randomized trial", Am J Kidney Dis, 59, pp.186~195 (2012)
  81. Theuwissen E, "Lowdose menaquinone-7 supplementation improved extra-hepatic vitamin K status, but had no effect on thrombin generation in healthy subjects", Br J Nutr, 108, pp.1652~1657 (2012)
  82. Vossen LM, "Menaquinone-7 supplementation to reduce vascular calcification in patients with coronary artery disease : rationale and study protocol(VitaK-CAC Trial)", Nutrients, 7, pp.8905~8915 (2015)
  83. Shoji T, "Atherogenic lipoprotein changes in the absence of hyperlipidemia in patients with chronic renal failure treated by hemodialysis", Atherosclerosis, 131, pp.229~236 (1997)
  84. Tamashiro M, "Significant association between the progression of coronary artery calcification and dyslipidemia in patients on chronic hemodialysis", Am J Kidney Dis, 38, pp.64~69 (2001)
  85. Shroff RC, "The vascular biology of calcification", Semin Dial, 20, pp.103~109 (2007)
  86. Goodman WG, "Vascular calcification in chronic kidney disease", Am J Kidney Dis, 43, pp.572~579 (2004)
  87. Nishizawa Y, "Atherosclerosis in uremia : possible roles of hyperparathyroidism and intermediate density lipoprotein accumulation", Kidney Int Suppl, 62, pp.S90~ (1997)[DOI]
  88. Schlemmer CK, "Ectopic calcification of rat aortas and kidneys is reduced with n-3fatty acid supplementation", Prostaglandins Leukot Essent Fatty Acids, 59, pp.221~227 (1998)
  89. Kanai S, "Eicosapentaenoic acid reduces warfarin-induced arterial calcification in rats", Atherosclerosis, 215, pp.43~51 (2011)
  90. Block RC, "Omega-6 and trans fatty acids in blood cell membranes: a risk factor for acute coronary syndromes?", Am Heart J, 156, pp.1117~1123 (2008)
  91. Paganelli F, "Altered erythrocyte n-3 fatty acids in Mediterranean patients with coronary artery disease", Int J Cardiol, 78, pp.27~32 (2001)
  92. An WS, "Comparison of fatty acid contents of erythrocyte membrane in hemodialysis and peritoneal dialysis patients", J Ren Nutr, 19, pp.267~274 (2009)
  93. Son YK, "Association between vascular calcification scores on plain radiographs and fatty acid contents of erythrocyte membrane in hemodialysis patients", J Ren Nutr, 22, pp.58~66 (2012)
  94. Ruiz-Gutierrez V, "Plasma lipids, erythrocyte membrane lipids and blood pressure of hypertensive women after ingestion of dietary oleic acid from two different sources", J Hypertens, 14, pp.1483~1490 (1996)
  95. Kim OY, "Impact of blood or erythrocyte membrane fatty acids for disease risk prediction: focusing on cardiovascular disease and chronic kidney disease", Nutrients, 10, pp.E1454~ (2018)
  96. An WS, "Omega-3 fatty acid supplementation increases 1, 25-dihydroxyvitamin D and fetuin-A levels in dialysis patients", Nutr Res, 32, pp.495~502 (2012)
  97. An WS, "Effect of omega-3 fatty acids on the modification of erythrocyte membrane fatty acid content including oleic acid in peritoneal dialysis patients", Prostaglandins Leukot Essent Fatty Acids, 86, pp.29~34 (2012)
  98. Blacher J, "Arterial calcifications, arterial stiffness, and cardiovascular risk in end-stage renal disease", Hypertension, 38, pp.938~942 (2001)
  99. Hall WL, "A high-fat meal enriched with eicosapentaenoic acid reduces postprandial arterial stiffness measured by digital volume pulse analysis in healthy men", J Nutr, 138, pp.287~291 (2008)
  100. Nestel P, "The n-3 fatty acids eicosapentaenoic acid and docosahexaenoic acid increase systemic arterial compliance in humans", Am J Clin Nutr, 76, pp.326~330 (2002)
  101. Schafer C, "The serum protein alpha 2-Heremans-Schmid glycoprotein", fetuin-A is a systemically acting inhibitor of ectopic calcification, 2003, pp.112, 357~366
  102. Hermans MM, "Study on the relationship of serum fetuin-A concentration with aortic stiffness in patients on dialysis", Nephrol Dial Transplant, 21, pp.1293~1299 (2006)
  103. Jung JY, "Factors associated with aortic stiffness and its change over time in peritoneal dialysis patients", Nephrol Dial Transplant, 25, pp.4041~4048 (2010)
  104. Stenvinkel P, "Low fetuin-A levels are associated with cardiovascular death : impact of variations in the gene encoding fetuin", Kidney Int, 67, pp.2383~2392 (2005)

관련 논문AI추천

이 간행물의 다른 논문 (28건)