METHODS: Secondary analysis of the VIKI study, involving 387 hemodialysis patients from 18 dialysis centers in Italy. Potential associations of diabetes mellitus, BGP levels, fractures, vascular calcifications were evaluated. Time-to-event analysis for all-cause mortality in patients with diabetes mellitus was performed by considering the Kaplan-Meier method. RESULTS: Patients with diabetes mellitus (88, 22%) had significant lower levels of total BGP ([139.00 (62.40, 220.5)] vs. [202.50

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... 362.30)] mcg/L, p<0.001), undercarboxylated (uc) BGP [9.24 (2.99, 15.54)] vs. [11.32 (6.15, 18.15)] mcg/L, p¼0.033) and 25(OH)D ([23.4 (16.5, 34.7)] vs. [30.2 (20.18, 46.78)] ng/ml, p<0.001). Lower total BGP levels were associated with aortic calcification (p<0.001), iliac calcification (p¼0.042) and vertebral fractures (p¼0.023). The regression model showed that diabetic patients had a statistically significant reduction of 19% of geometric mean both of total BGP (parameter estimate¼-0.21092; p¼0.0085; R 2 ¼0.53) and of 25.6% of geometric mean of ucBGP (parameter estimate¼-0.0341; p¼0.0085; R 2 ¼0.17). 77 patients died during a 2.7 6 0.5 year follow-up. In univariate Cox regression analysis, patients with diabetes mellitus had a higher risk of all-cause mortality (HR: 1.826, 95% CI: 1.127-2.958, p¼0.014). CONCLUSIONS: In HD patients, diabetes mellitus is associated with decreased BGP levels and increased mortality, suggesting a clinically significant reduced protection by BGP of bone and vascular health