PTH and obesity due to melanocortin 4 receptor deficiency: Typically present in stage 5D CKD, its incidencereaches about 35 cases for every 10,000 patients on dialysis, yielding worryingprognosis, with mortality rates greater than 50% .6 There are several risk factors, linked or not to CKD, with emphasison: female gender, obesity, diabetes, hypoalbuminemia, use of warfarin and bonemineral disorder - especially adynamic bone disease and hyperphosphatemia.8,9 High levels of parathyroid hormone (PTH) arenot associated with a higher incidence of calciphylaxis.10,11 The role of vitamin K is particularlyimportant in this condition.