Matrix Gla protein (MGP) and bone Gla protein (BGP) are two vitamin K-dependent proteins (VKDPs) involved in the regulation of vascular calcification (VC). We carried out a secondary analysis of the VIKI study to evaluate associations between drug consumption and VKDP levels in 387 hemodialyzed patients. The VIKI study assessed the prevalence of vitamin K deficiency in hemodialysis patients. We evaluated drug consumption, determined BGP and MGP levels, and verified the presence of any vertebral fractures (VF) and VC by spine radiographs. Total BGP levels were twice as high with calcimimetics versus no calcimimetics (290 vs. 158.5 mcg/L, p < 0.0001) and 69 % higher with vitamin D analogs (268 vs. 159 mcg/L, p < 0.0001). Total MGP was 19 % higher with calcimimetics (21.5 vs. 18.1 mcg/L, p = 0.04) and 54 % higher with calcium acetate (27.9 vs. 18.1 mcg/L, p = 0.003); no difference was found with vitamin D analogs (21.1 vs. 18.3 mcg/L, p = 0.43). Median Total BGP level was 29 % lower in patients with ≥1 VF (151 vs. 213 mcg/L, p = 0.0091) and 36 % lower in patients with VC (164 vs. 262.1 mcg/L, p = 0.0003). In non-survivors, median BGP and MGP were lower, but only for MGP this difference reached the statistical significance (152 vs. 191 mcg/L, p = 0.20 and 15.0 vs. 19.7 mcg/L, p = 0.02, respectively). Pending studies on vitamin K supplementation, calcimimetics, and vitamin D analogs may play a role in preserving vitamin K-dependent protein activity, thus contributing to bone and vascular health in CKD patients.

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An 80-year-old woman presented with a history of hypertension, chronic obstructive pulmonary disease (COPD), peripheral vascular disease, and chronic renal failure (stage 5, estimated glomerular filtration rate (eGFR): 12.6 mL/min/1.73 m 2), previously treated for abdominal aortic aneurysm by endovascular aneurysm repair (EVAR). The patient was regularly followed at the nephrology clinic and was evaluated by the vascular surgeon for the placement of a vascular access (VA), in preparation for dialysis treatment. The duplex scan examination showed postphlebitic fibrosis of the cephalic veins in both arms and a small size of both basilic veins (2.5 mm diameter). In this case, given the poorness of the autologous superficial venous system, the patient was treated through a prosthetical left omero-axillary arteriovenous bypass. The procedure was performed in local anesthesia (LA) using a Gore Hybrid ® (W. L. Gore & Associates, Inc., Flagstaff, AZ, USA) vascular graft. This choice was done since the patient did not need an immediate ultrafiltration (whereby an early

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