Insights into vitamin K metabolism in chronic kidney disease: more complicated than kale deficiency

Vascular calcification is a major manifestation of cardiovascular disease in advanced chronic kidney disease and is inhibited by vitamin K–dependent proteins. Clinical trials of vitamin K supplementation in chronic kidney disease have failed to demonstrate benefits on vascular calcification. Recent laboratory, human, and animal studies have shown that vitamin K handling and metabolism in chronic kidney disease is complex and suggest vitamin K2 subtype supplementation in isolation is unlikely to have significant clinical impact