Premium
Oral Calcitriol Use, Vertebral Fractures, and Vitamin K in Hemodialysis Patients: A Cross‐Sectional Study
Author(s) -
Fusaro Maria,
Cianciolo Giuseppe,
Tripepi Giovanni,
Plebani Mario,
Aghi Andrea,
Politi Cristina,
Zaninotto Martina,
Nickolas Thomas L.,
Ferrari Serge,
Ketteler Markus,
La Manna Gaetano,
Gasperoni Lorenzo,
Messa Piergiorgio,
Ravera Maura,
Gallieni Maurizio,
Cosmai Laura,
Locatelli Francesco,
Iervasi Giorgio,
Vettor Roberto,
Mereu Maria Cristina,
Sella Stefania,
Arcidiacono Gaetano,
Giannini Sandro
Publication year - 2021
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.4440
Subject(s) - calcitriol , medicine , hyperphosphatemia , parathyroid hormone , vitamin d and neurology , endocrinology , kidney disease , fibroblast growth factor 23 , osteocalcin , bone remodeling , odds ratio , gastroenterology , hemodialysis , calcium , alkaline phosphatase , biology , biochemistry , enzyme
Fractures and vascular calcifications (VCs) are common in patients with chronic kidney disease (CKD). They are related to abnormalities in vitamin D metabolism, calcium, phosphorus, parathyroid hormone, and fibroblast growth factor 23 (FGF23)/Klotho that occur with CKD. Impaired vitamin D metabolism and abnormal levels of calcium, phosphate, parathyroid hormone (PTH), and FGF23/Klotho drive bone and vascular changes in CKD. It is unclear if oral calcitriol safely mitigates fracture risk without increasing the burden of calcifications. Therefore, we investigated whether treatment with calcitriol affected the prevalence of fractures and VC progression in hemodialysis (HD) patients. This report is a secondary analysis of the Vitamin K Italian (VIKI) study, a cross‐sectional study involving 387 HD patients. We assessed vitamin 25(OH)D, alkaline phosphatase, PTH, calcium, phosphate, osteocalcin or bone Gla protein, matrix Gla protein, and vitamin K levels. Vertebral fractures (VFs) and VCs were determined by spine radiograph. A reduction of >20% of vertebral body height was considered a VF. VCs were quantified by the length of calcific lesions along the arteries. The patients treated with oral calcitriol were 177 of 387 patients (45.7%). The prevalence of VF was lower in patients receiving oral calcitriol than in those untreated (48.6% versus 61.0%, p = 0.015), whereas the presence of aortic and iliac calcifications was similar (aortic: 81.9% versus 79.5%, respectively, p = 0.552; iliac: 52.0% and 59.5%, respectively, p = 0.167). In multivariable logistic regression analysis, oral calcitriol was associated with a 40.2% reduced odds of fracture (OR 0.598; 95% confidence interval [CI], 0.363–0.985; p = 0.043). In conclusion, we found a significant association between oral calcitriol and lower VF in HD patients without an increase in the burden of VC. Further prospective and interventional studies are needed to confirm these findings. © 2021 American Society for Bone and Mineral Research (ASBMR).