In addition to the remodelling of the aortic root as a result of increased stress on the aortic wall due to hypertension, the cause of aortic root dilatation in CKD seems to be due to mechanisms similar to those responsible for decreased large artery elasticity in CKD patients, such as endothelial dysfunction, renin-angiotensin-aldosterone system and endothelin system activation, inflammation, oxidative stress and lipid peroxidation27. This evidence concerns the gene REN and endothelial dysfunction.