4. Discussion
gastrointestinal events, CKD, cardiovascular disease, ESKD, vascular calcification, thrombotic, arterial stiffness, vascular stiffness, nausea, vomiting, diabetes
CARDIOVASCULAR DISEASE, ADVERSE EVENTS, VASCULAR CALCIFICATION, ADVERSE EFFECTS, VITAMIN K DEFICIENCY, ARTERIAL STIFFNESS, EVENTS, DIABETES
This study represents the first RCT to investigate the impact of vitamin K2 supplementation on vascular stiffness in ESKD patients who had high risk of cardiovascular disease due to severe arterial stiffness as determined by PWV. Following a 24-week intervention period, no significant difference in cfPWV between groups was demonstrated. However, the oral MK-7 group showed a greater reduction in cfPWV among patients with diabetes compared with the control group. The MK-7 group did exhibit an ability to slow the progression of arterial stiffness, which was more pronounced in patients with diabetes.Vitamin K serves as a crucial cofactor for MGP in inhibiting vascular calcification. The main objective of vitamin K supplementation is to alleviate subclinical vitamin K deficiency and inhibit the progression of vascular calcification in patients with CKD and ESKD. Vitamin K supplementation has been shown to reduce plasma dp-ucMGP levels, indicating an improvement in vitamin K deficiency in CKD patients [Patients with DM generally have an accelerated risk of developing vascular stiffness, even if they have normal renal function. Previous studies have shown that the increase in patients with the degree of PWV in DM is correlated with higher levels of plasma dp-ucMGP in patients with DM even without CKD [Our prior investigation revealed that serum calcium and hemodialysis adequacy were independently associated risk factors with an increase in arterial stiffness in addition to blood sugar [Another noteworthy finding of this study is that MK-7 was well-tolerated by ESKD patients, with only mild adverse effects reported. The most common adverse events observed were gastrointestinal events, including nausea, vomiting, and abdominal discomfort, all of which could be alleviated with supportive treatment with antiemetic medication. Additionally, taking the supplement at bedtime was shown to reduce these effects. Importantly, no fatal thrombotic events were observed after vitamin K supplementation, which is supported by previous reports [It is important to acknowledge the limitations of our study. Firstly, the main outcome measured in our study was the change in cfPWV. Although cfPWV has been accepted as a standard tool for the assessment of arterial stiffness [