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Updated: Feb 6, 2026
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
The role of kidney transplantation and phosphate binder use in vitamin K status
Thijs T Jansz1, Aegida Neradova2, Adriana J van Ballegooijen2,3,4
1Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Insights
Kidney transplant recipients show improved vitamin K status, indicated by lower dp-ucMGP levels. However, sevelamer use in dialysis patients may worsen vitamin K status, highlighting the need for monitoring.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Nutritional Science
Background:
- Cardiovascular disease (CVD) is the primary cause of mortality in end-stage renal disease (ESRD) patients, with vascular calcification being a significant contributor.
- Both kidney transplantation and phosphate binders are explored for their potential to mitigate vascular calcification risk in ESRD.
- Matrix γ-carboxyglutamic acid protein (MGP), a vitamin K-dependent protein, actively inhibits vascular calcification, but the impact of transplantation and phosphate binders on vitamin K status remains unclear.
Purpose of the Study:
- To investigate the influence of kidney transplantation on vitamin K status in ESRD patients.
- To determine the effect of phosphate binder use on vitamin K status in ESRD patients.
- To assess plasma desphospho-uncarboxylated MGP (dp-ucMGP) as a marker for vitamin K status in these populations.
Main Methods:
- A cross-sectional study measured plasma dp-ucMGP levels in hemodialysis (n=82), peritoneal dialysis (n=31), and kidney transplant recipients (n=36).
- Phosphate binder usage was assessed via medication inventory.
- Linear regression analysis was employed to evaluate the association between kidney transplantation, phosphate binder use, and dp-ucMGP levels, adjusting for confounders.
Main Results:
- Kidney transplant recipients exhibited significantly lower dp-ucMGP levels (median 689 pmol/L) compared to dialysis patients (median 1537 pmol/L, p<0.001), suggesting improved vitamin K status post-transplantation.
- Overall phosphate binder use was not significantly associated with dp-ucMGP levels (p=0.09).
- Sevelamer monotherapy was associated with higher dp-ucMGP levels (median 1740 pmol/L, p=0.04), indicating a potential worsening of vitamin K status.
Conclusions:
- Kidney transplantation appears to improve vitamin K status, as evidenced by reduced dp-ucMGP levels.
- Sevelamer monotherapy may negatively impact vitamin K status in dialysis patients.
- These findings underscore the importance of monitoring vitamin K status in dialysis patients, given vitamin K's role in preventing vascular calcification.
Background:
Cardiovascular disease is the leading cause of death in end-stage renal disease and is strongly associated with vascular calcification. Both kidney transplantation and phosphate binders may lower the risk of vascular calcification. Vascular calcification is actively inhibited by vitamin-K-dependent matrix γ-carboxyglutamic acid protein (MGP). Whether kidney transplantation or phosphate binders affect vitamin K status is unknown. Therefore, we studied the influence of kidney transplantation and phosphate binder use on vitamin K status.
Methods:
We measured plasma desphospho-uncarboxylated MGP (dp-ucMGP), a marker reflecting low vitamin K status, in a cross-sectional study of patients on hemodialysis (n = 82), peritoneal dialysis (n = 31) or who recently received a kidney transplantation (n = 36). By medication inventory, we assessed phosphate binder use. With linear regression, we assessed the influence of kidney transplantation and phosphate binder use on natural-log-transformed dp-ucMGP, adjusting for potential confounders.
Results:
Mean age of patients was 52±13 years; 102 (68%) were male. Dp-ucMGP levels were significantly lower in kidney transplant recipients (median 689 pmol/L) compared to patients on dialysis (median 1537 pmol/L, p<0.001). Eighty-nine patients on dialysis used phosphate binders. Using any phosphate binder was not associated with dp-ucMGP levels (median 1637 pmol/L, p = 0.09) compared to no phosphate binders (median 1142 pmol/L). Twenty-six patients used sevelamer monotherapy, which was associated with higher dp-ucMGP levels (median 1740 pmol/L, p = 0.04) after adjusting for age, sex and vitamin K antagonist use.
Conclusions:
Recent kidney transplantation is associated with lower dp-ucMGP levels suggesting improved vitamin K status after transplantation. Sevelamer monotherapy is associated with higher dp-ucMGP levels suggesting worsening of vitamin K status. Both findings warrant more attention to vitamin K status in patients on dialysis, as vitamin K is necessary for protection against vascular calcification.
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