Patients with kidney disease have (a) non traditional risk factors (increased inflammation from oxidative stress, asymmetric dimethylarginine that inhibits nitric oxide, hyperhomocysteinaemia, sympathetic over activity triggering vascular injury and endothelial dysfunction) and (b) uremia risk factors (uremic toxins, sodium and water retention, anemia and malnutrition, abnormal calcium and phosphorous metabolism, hyperparathyroidism and decreased Klotho protein expression) that contribute to increased cardiovascular risk [36–41]. Here, KL is linked to endothelial dysfunction.