Vitamin K1 to Slow Progression of Vascular Calcification in HD Patients (VitaVasK)

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2012 by RWTH Aachen University
Sponsor:
Information provided by (Responsible Party):
RWTH Aachen University
ClinicalTrials.gov Identifier:
NCT01742273
First received: December 3, 2012
Last updated: January 3, 2014
Last verified: July 2012

December 3, 2012
January 3, 2014
October 2013
September 2019   (final data collection date for primary outcome measure)
Progression of coronary artery calcification and thoracic aortic calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
Progression of coronary artery calcification and thoracic aortic calcification(absolute change of the volume score at the 18-month MSCT versus the baseline MSCT)
  • Progression of coronary artery calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of coronary artery calcification (absolute change of the volume score at the 18-month MSCT versus the baseline MSCT)
  • Progression of thoracic aortic calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of coronary artery calcification (absolute change of the volume score at the 18-month MSCT versus the baseline MSCT)
Complete list of historical versions of study NCT01742273 on ClinicalTrials.gov Archive Site
  • Progression of aortic valve calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of aortic valve calcification (absolute change of the Agatston-Score and volume score at the 18-month MSCT versus the baseline MSCT)
  • Progression of mitral valve calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of mitral valve calcification (absolute change of the Agatston-Score and volume score at the 18-month MSCT versus the baseline MSCT)
  • Mortality from any cause within 18 months after the treatment [ Time Frame: 6 years ] [ Designated as safety issue: No ]
    Mortality from any cause within 18 months after the treatment
  • Major adverse cardiovascular events: myocardial infarction, stroke, acute coronary syndrome,embolism, symptom-driven revascularization, death from cardiovascular cause within 18 months after start of treatment [ Time Frame: 6 years ] [ Designated as safety issue: No ]
    Major adverse cardiovascular events: myocardial infarction, stroke, acute coronary syndrome,embolism, symptom-driven revascularization, death from cardiovascular cause within 18 months after start of treatment
  • Progression of thoracic aortic calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of thoracic aortic calcification (absolute change of the Agatston score at the 18-month MSCT)
  • Progression of coronary artery calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of coronary artery calcification (absolute change of the Agatston score at the 18-month MSCT versus the baseline MSCT)
  • Progression of aortic valve calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of aortic valve calcification (absolute change of the Agatston and volume scores at the 18-month MSCT versus the baseline MSCT)
  • Progression of mitral valve calcification [ Time Frame: 18 months ] [ Designated as safety issue: No ]
    Progression of mitral valve calcification (absolute change of the Agatston and volume scores at the 18-month MSCT versus the baseline MSCT)
  • Mortality from any cause within 18 months after the treatment [ Time Frame: 6 years ] [ Designated as safety issue: No ]
    Mortality from any cause within 18 months after the treatment
  • Major adverse cardiovascular events: myocardial infarction, stroke, acute coronary syndrome,embolism, symptom-driven revascularization, death from cardiovascular cause within 18 months after start of treatment [ Time Frame: 6 years ] [ Designated as safety issue: No ]
    Major adverse cardiovascular events: myocardial infarction, stroke, acute coronary syndrome,embolism, symptom-driven revascularization, death from cardiovascular cause within 18 months after start of treatment
Not Provided
Not Provided
 
Vitamin K1 to Slow Progression of Vascular Calcification in HD Patients
Vitamin K1 to Slow Progression of Vascular Calcification in Hemodialysis Patients

Patients on hemodialysis (HD) exhibit an immensely increased cardiovascular mortality associated with extensive vascular calcification (VC). In the past years the development of VC was discovered to be actively regulated and as being influenced by inhibitors of calcification (e.g. matrix-Gla-protein, fetuin-A). MGP is produced by vascular smooth muscle cells and needs post-translational modification by vitamin K dependent gamma-carboxylation to be fully active. Based on the demonstration of increased PIVKA-II levels, about 97% of all HD patients exhibit insufficient carboxylation activity. We therefore aim in this randomized, controlled study to retard the progress of coronary and aortal calcification as assessed by thoracic multislice-CT by the thrice weekly administration of 5 mg vitamin K1 (phylloquinone) to a total of 348 HD patients over a period of 18 months.

Patients on hemodialysis (HD) exhibit an immensely increased cardiovascular mortality associated with extensive vascular calcification (VC). This forms - at least partially - the reason for the excessively increased cardiovascular mortality in this population.

In the past years the development of VC was discovered to be actively regulated and as being influenced by inhibitors of calcification (e.g. matrix-Gla-protein, fetuin-A). Matrix Gla protein (MGP) is a powerful vascular wall-based inhibitor of VC. MGP is produced by vascular smooth muscle cells and needs post-translational modification by vitamin K dependent gamma-carboxylation to be fully active. The role of MGP was discovered in knock-out mice, which died from rupture of a massively calcified aorta. Functional vitamin K deficiency induced by administration of warfarin leads to the development of VC, which in turn can be inhibited by subsequent administration of vitamin K1. Warfarin inhibits the vitamin K mediated gamma-carboxylation, which leads to the production of noncarboxylated and inactive MGP (ucMGP).

Warfarin is widely used due to its inhibitory capacity on the activation of coagulation factors. Now it has been discovered that the use of vitamin K inhibitors influences vascular health: long-term use of warfarin is associated with an increased prevalence and extent of VC in the normal population and HD patients. Warfarin is also a crucial risk factor for the development of calciphylaxis, a life-threatening complication in HD patients characterised by calcified cutaneous vessels. In turn, administration of vitamin K1 was accompanied by reduced intima-media-thickness (IMT) and increased elasticity of vessels in postmenopausal women.

Based on the demonstration of increased PIVKA-II levels, about 97% of all HD patients exhibit insufficient carboxylation activity. Together with the increased VC they represent an ideal population for interventional trials in the vitamin K system. Recently we were able to demonstrate that supplementation of vitamin K1 in such patients is well tolerated, shows only very few side effects and induces a dose dependent decrease of the inactive form Dephosphorylated noncarboxylated matrix Gla protein (dpucMGP) in serum over a six weeks period. In this trial we also observed that all dialysis patients included had insufficient vitamin K serum levels, indicating no substantial influence of food intake on vitamin K deficiency. In addition, this demonstrates that all patients have insufficient vitamin K levels to facilitate adequate MGP carboxylation.

Interventional
Phase 3
Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Vitamin K1 to Slow the Progression of Thoracic Aortic and Coronary Artery Calcification
Drug: Vitamin K1
Vitamin K1 to slow vascular calcification
  • No Intervention: standard treatment (usual care)
    standard treatment (usual care)
  • Experimental: Vitamin K1
    Vitamin K1 (phylloquinone), thrice weekly p.o. (5mg)
    Intervention: Drug: Vitamin K1
Not Provided

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruiting
348
Not Provided
September 2019   (final data collection date for primary outcome measure)

Inclusion Criteria:

  • Male or Female minimum 18 years of age
  • Not less than 6 months on hemodialysis
  • Cardiovascular calcification percent (coronary artery volume score > 100)
  • Written consent to take part in the study
  • Life expectancy not less than 18 months

Exclusion Criteria:

  • Known hypersensitivity against Vitamin K1
  • History of thrombosis
  • Intake of vitamin K antagonists (e.g. Marcumar) at baseline or in the 3 months prior to baseline
  • Inflammatory bowel disease
  • Short-bowel syndrome
  • Significant liver dysfunction
  • Coronary stent
  • Hemoglobin < 70 g/L
  • Women who are pregnant or breastfeeding
  • Alcohol or drug abuse
  • Mental condition rendering the subject unable to understand the nature, scope and possible consequences of the study
  • Subject unlikely to comply with protocol, e.g. uncooperative attitude, inability to return for follow-up-visits and unlikelihood of completing the study
  • Participation in a parallel clinical trial or participation in another clinical trial within the previous 3 months
  • Subjects who are in any state of dependency to the sponsor or the investigators
  • Employees of the sponsor or the investigators
  • Subjects who have been committed to an institution by legal or regulatory order
Both
18 Years and older
No
Contact: Jürgen Floege, Prof. Dr. 0049 241 80-89530 juergen.floege@rwth.aachen.de
Germany,   Sweden,   Poland,   Netherlands,   Italy,   Belgium
 
NCT01742273
VitaVasK, 2010-021264-14
Not Provided
RWTH Aachen University
RWTH Aachen University
Not Provided
Principal Investigator: Jürgen Floege, Prof. Dr. University Hospital of RWTH Aachen -Department of Medicine II, Nephrology and Clinical Immunology
RWTH Aachen University
July 2012

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP