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Ziemińska M, Sieklucka B, Pawlak K. Vitamin K and D Supplementation and Bone Health in Chronic Kidney Disease-Apart or Together? Nutrients 2021; 13:nu13030809. [PMID: 33804453 PMCID: PMC7999920 DOI: 10.3390/nu13030809] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022] Open
Abstract
Vitamin K (VK) and vitamin D (VD) deficiency/insufficiency is a common feature of chronic kidney disease (CKD), leading to impaired bone quality and a higher risk of fractures. CKD patients, with disturbances in VK and VD metabolism, do not have sufficient levels of these vitamins for maintaining normal bone formation and mineralization. So far, there has been no consensus on what serum VK and VD levels can be considered sufficient in this particular population. Moreover, there are no clear guidelines how supplementation of these vitamins should be carried out in the course of CKD. Based on the existing results of preclinical studies and clinical evidence, this review intends to discuss the effect of VK and VD on bone remodeling in CKD. Although the mechanisms of action and the effects of these vitamins on bone are distinct, we try to find evidence for synergy between them in relation to bone metabolism, to answer the question of whether combined supplementation of VK and VD will be more beneficial for bone health in the CKD population than administering each of these vitamins separately.
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Affiliation(s)
- Marta Ziemińska
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, 15-222 Bialystok, Poland;
| | - Beata Sieklucka
- Department of Pharmacodynamics, Medical University of Bialystok, 15-222 Bialystok, Poland;
| | - Krystyna Pawlak
- Department of Monitored Pharmacotherapy, Medical University of Bialystok, 15-222 Bialystok, Poland;
- Correspondence: ; Tel.: +48-85-748-5600
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Allen MR, Wallace J, McNerney E, Nyman J, Avin K, Chen N, Moe S. N-acetylcysteine (NAC), an anti-oxidant, does not improve bone mechanical properties in a rat model of progressive chronic kidney disease-mineral bone disorder. PLoS One 2020; 15:e0230379. [PMID: 32203558 PMCID: PMC7089527 DOI: 10.1371/journal.pone.0230379] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/27/2020] [Indexed: 01/17/2023] Open
Abstract
Individuals with chronic kidney disease have elevated levels of oxidative stress and are at a significantly higher risk of skeletal fracture. Advanced glycation end products (AGEs), which accumulate in bone and compromise mechanical properties, are known to be driven in part by oxidative stress. The goal of this study was to study effects of N-acetylcysteine (NAC) on reducing oxidative stress and improving various bone parameters, most specifically mechanical properties, in an animal model of progressive CKD. Male Cy/+ (CKD) rats and unaffected littermates were untreated (controls) or treated with NAC (80 mg/kg, IP) from 30 to 35 weeks of age. Endpoint measures included serum biochemistries, assessments of systemic oxidative stress, bone morphology, and mechanical properties, and AGE levels in the bone. CKD rats had the expected phenotype that included low kidney function, elevated parathyroid hormone, higher cortical porosity, and compromised mechanical properties. NAC treatment had mixed effects on oxidative stress markers, significantly reducing TBARS (a measure of lipid peroxidation) while not affecting 8-OHdG (a marker of DNA oxidation) levels. AGE levels in the bone were elevated in CKD animals and were reduced with NAC although this did not translate to a benefit in bone mechanical properties. In conclusion, NAC failed to significantly improve bone architecture/geometry/mechanical properties in our rat model of progressive CKD.
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Affiliation(s)
- Matthew R. Allen
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Department of Biomedical Engineering, Indiana University—Purdue University, Indianapolis, IN, United States of America
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Roudebush VA Medical Center, Indianapolis, IN, United States of America
| | - Joseph Wallace
- Department of Biomedical Engineering, Indiana University—Purdue University, Indianapolis, IN, United States of America
| | - Erin McNerney
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Jeffry Nyman
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Keith Avin
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Neal Chen
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Sharon Moe
- Department of Anatomy, Cell Biology and Physiology, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Roudebush VA Medical Center, Indianapolis, IN, United States of America
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Avin KG, Allen MR, Chen NX, Srinivasan S, O'Neill KD, Troutman AD, Mast G, Swallow EA, Brown MB, Wallace JM, Zimmers TA, Warden SJ, Moe SM. Voluntary Wheel Running Has Beneficial Effects in a Rat Model of CKD-Mineral Bone Disorder (CKD-MBD). J Am Soc Nephrol 2019; 30:1898-1909. [PMID: 31501355 DOI: 10.1681/asn.2019040349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/16/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Reduced bone and muscle health in individuals with CKD contributes to their higher rates of morbidity and mortality. METHODS We tested the hypothesis that voluntary wheel running would improve musculoskeletal health in a CKD rat model. Rats with spontaneous progressive cystic kidney disease (Cy/+ IU) and normal littermates (NL) were given access to a voluntary running wheel or standard cage conditions for 10 weeks starting at 25 weeks of age when the rats with kidney disease had reached stage 2-3 of CKD. We then measured the effects of wheel running on serum biochemistry, tissue weight, voluntary grip strength, maximal aerobic capacity (VO2max), body composition and bone micro-CT and mechanics. RESULTS Wheel running improved serum biochemistry with decreased creatinine, phosphorous, and parathyroid hormone in the rats with CKD. It improved muscle strength, increased time-to-fatigue (for VO2max), reduced cortical porosity and improved bone microarchitecture. The CKD rats with voluntary wheel access also had reduced kidney cystic weight and reduced left ventricular mass index. CONCLUSIONS Voluntary wheel running resulted in multiple beneficial systemic effects in rats with CKD and improved their physical function. Studies examining exercise interventions in patients with CKD are warranted.
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Affiliation(s)
- Keith G Avin
- Division of Nephrology and .,Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Matthew R Allen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Neal X Chen
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Shruthi Srinivasan
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Kalisha D O'Neill
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana
| | - Ashley D Troutman
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Garrison Mast
- Departments of Medicine, Anatomy and Cell Biology, and
| | | | - Mary Beth Brown
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and
| | - Joseph M Wallace
- Division of Nephrology and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Teresa A Zimmers
- Medicine and General Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, Indianapolis, Indiana; and.,Departments of Medicine, Anatomy and Cell Biology, and
| | - Sharon M Moe
- Division of Nephrology and.,Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.,Departments of Medicine, Anatomy and Cell Biology, and
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Bisson SK, Ung RV, Picard S, Valade D, Agharazii M, Larivière R, Mac-Way F. High calcium, phosphate and calcitriol supplementation leads to an osteocyte-like phenotype in calcified vessels and bone mineralisation defect in uremic rats. J Bone Miner Metab 2019; 37:212-223. [PMID: 29603070 DOI: 10.1007/s00774-018-0919-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 02/20/2018] [Indexed: 11/26/2022]
Abstract
A link between vascular calcification and bone anomalies has been suggested in chronic kidney disease (CKD) patients with low bone turnover disease. We investigated the vascular expression of osteocyte markers in relation to bone microarchitecture and mineralization defects in a model of low bone turnover CKD rats with vascular calcification. CKD with vascular calcification was induced by 5/6 nephrectomy followed by high calcium and phosphate diet, and vitamin D supplementation (Ca/P/VitD). CKD + Ca/P/VitD group (n = 12) was compared to CKD + normal diet (n = 12), control + normal diet (n = 8) and control + Ca/P/VitD supplementation (n = 8). At week 6, tibia, femurs and the thoracic aorta were analysed by Micro-Ct, histomorphometry and for expression of osteocyte markers. High Ca/P/VitD treatment induced vascular calcification only in CKD rats, suppressed serum parathyroid hormone levels and led to higher sclerostin, DKK1 and FGF23 serum levels. Expression of sclerostin, DKK1 and DMP1 but not FGF23 were increased in calcified vessels from CKD + Ca/P/VitD rats. Despite low parathyroid hormone levels, tibia bone cortical thickness was significantly lower in CKD + Ca/P/VitD rats as compared to control rats fed a normal diet, which is likely the result of radial growth impairment. Finally, Ca/P/VitD treatment in CKD rats induced a bone mineralization defect, which is likely explained by the high calcitriol dose. In conclusion, Ca/P/VitD supplementation in CKD rats induces expression of osteocyte markers in vessels and bone mineralisation anomalies. Further studies should evaluate the mechanisms of high dose calcitriol-induced bone mineralisation defects in CKD.
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Affiliation(s)
- Sarah-Kim Bisson
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Roth-Visal Ung
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Sylvain Picard
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Danika Valade
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Mohsen Agharazii
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Richard Larivière
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada
| | - Fabrice Mac-Way
- Endocrinology and Nephrology Axis, Faculty and Department of Medicine, L'Hôtel-Dieu de Québec Hospital, CHU de Québec Research Center, Université Laval, 10 McMahon, Quebec City, QC, G1R 2J6, Canada.
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