In our cohort study, a reduction in GRP levels associate with an increase in levels of the VC promoters P, FGF-23 and CaxP, and a decrease in the VC inhibitor α-Klotho, clearly showing a correlation between GRP and the dysregulation of phosphate metabolism characteristic of CKD-MBD. This evidence concerns the gene KL and Marchiafava-Bignami disease.