The mechanisms for
vascular calcification and its associated cardiovascular mortality in patients with
ESRD are not completely understood. Dialysis patients exhibit profound
vitamin K deficiency, which may impair carboxylation of the calcification inhibitor
matrix gla protein (MGP). Here, we tested whether distinct circulating inactive
vitamin K-dependent
proteins associate with all-cause or cardiovascular mortality. We observed higher levels of both desphospho-uncarboxylated MGP (dp-ucMGP) and desphospho-carboxylated MGP (dp-cMGP) among 188
hemodialysis patients compared with 98 age-matched subjects with normal renal function. Levels of dp-ucMGP correlated with those of
protein induced by
vitamin K absence II (
PIVKA-II; r = 0.62, P < 0.0001). We found increased
PIVKA-II levels in 121 (64%) dialysis patients, indicating pronounced
vitamin K deficiency. Kaplan-Meier analysis showed that patients with low levels of dp-cMGP had an increased risk for all-cause and cardiovascular mortality. Multivariable Cox regression confirmed that low levels of dp-cMGP increase mortality risk (all-cause: HR, 2.2; 95% CI, 1.1 to 4.3; cardiovascular: HR, 2.7; 95% CI, 1.2 to 6.2). Furthermore, patients with higher
vascular calcification scores showed lower levels of dp-cMGP. In 17
hemodialysis patients, daily supplementation with
vitamin K2 for 6 weeks reduced dp-ucMGP levels by 27% (P = 0.003) but did not affect dp-cMGP levels. In conclusion, the majority of dialysis patients exhibit pronounced
vitamin K deficiency. Lower levels of circulating dp-cMGP may serve as a predictor of mortality in dialysis patients. Whether
vitamin K supplementation improves outcomes requires further study.