The associations between functional vitamin K status and all‐cause mortality, cardiovascular disease and end‐stage kidney disease in persons with type 1 diabetes.

Background and Aim: Vitamin K deficiency is common in persons with kidney disease, which is a known complication of diabetes. We aimed to assess the association of vitamin K status as reflected by plasma dephosphorylated‐uncarboxylated matrix Gla protein (dp‐ucMGP) with mortality, cardiovascular disease (CVD) and progression to end‐stage kidney disease (ESKD) in persons with type 1 diabetes. Materials and Methods: We analysed plasma dp‐ucMGP in stored baseline samples from a cohort of 667 persons with type 1 diabetes (baseline visit: 2009–2011). Information on mortality and CVD was obtained through linkage to registers. Cox‐proportional hazards models were applied to estimate hazard ratios (HRs) of mortality, CVD and ESKD per one doubling of dp‐ucMGP. Results: A total of 53 deaths were recorded during follow‐up. Persons with higher dp‐ucMGP (reflecting lower vitamin K status) had higher mortality in the unadjusted model (HR: 2.06 [95% confidence interval—CI: 1.22–3.45]), but not in the fully adjusted model (HR: 0.88 [95% CI: 0.44–1.73]). Particularly, adjustment for glomerular filtration rate and urinary albumin excretion rate attenuated the HR. A similar pattern was observed in unadjusted models for incidence of CVD (HR: 1.58 [95% CI: 1.03–2.42]) and risk of ESKD (HR: 7.62 [95% CI: 4.25–13.68]). In the fully adjusted models, the HRs became statistically insignificant. Conclusion: In persons with type 1 diabetes, lower vitamin K status was associated with higher mortality, CVD and progression to ESKD, however, not after adjustment for other risk factors. Interventional studies are needed to elucidate the role of vitamin K in persons with type 1 diabetes. [ABSTRACT FROM AUTHOR]