Vitamin K and cardiovascular calcification in CKD: is patient supplementation on the horizon?

The vitamin K-dependent proteins (VKDPs) matrix Gla protein and osteocalcin protect from cardiovascular calcifications and bone fractures. A vitamin K recycling system maintains sufficient vitamin K levels for activation of VKDPs through gamma-glutamyl carboxylase (GGCX). Kaesler et al. demonstrate that uremia per se can interfere with GGCX activity, contributing to vitamin K deficiency in chronic kidney disease and opening the path to the clinical use of vitamin K, currently tested in randomized trials.