Clinical significance of serum calcium-phosphorus product, parathyroid hormone, vitamin K2 in chronic kidney disease patients with coronary artery calcification

Coronary artery calcification (CAC) is a major cardiovascular complication in chronic kidney disease (CKD) driven by disrupted calcium-phosphorus metabolism, secondary hyperparathyroidism, and vitamin K2 deficiency. Although CAC predicts cardiovascular events, the roles of calcium-phosphorus product (Ca × P), parathyroid hormone (PTH), and vitamin K2 in CAC progression and diagnosis remain underexplored. This study examines clinical and biochemical factors linked to CAC in CKD and evaluates the diagnostic potential of these biomarkers individually and in combination. This retrospective analysis included 368 CKD patients divided into CAC (<i>n</i> = 216) and non-CAC (<i>n</i> = 152) groups based on coronary computed tomography angiography. Serum Ca × P, PTH, and vitamin K2 levels were assessed <i>via</i> biochemical assays, and CAC severity was quantified using Agatston scores. Correlations between biomarkers and CAC scores were analyzed, and ROC analysis determined the diagnostic performance of individual and combined biomarkers. CAC patients exhibited higher Ca × P and PTH levels and lower vitamin K2 levels than non-CAC patients. Ca × P and PTH positively correlated, while both inversely correlated with vitamin K2. CAC severity correlated positively with Ca × P and PTH but negatively with vitamin K2. The combined biomarker model achieved an AUC of 0.88, with 82.41% sensitivity and 77.63% specificity, surpassing individual markers. Ca × P, PTH, and vitamin K2 significantly correlated with CAC pathogenesis and severity in CKD. Their combination could potentially improve diagnostic accuracy, offering a promising approach for early detection and management of CAC in CKD patients.