Multiple mechanisms may contribute to the development of uremic cardiomyopathy, including non-CKD specific factors, such as hypertension, hemodynamic overload, overactivation of the renin–angiotensin–aldosterone system (RAAS), and sympathetic nervous system, endothelial dysfunction, inflammation, and increased nitro-oxidative stress, as well as CKD-specific factors, including circulating uremic toxins and renal anemia4,8. Here, REN is linked to chronic kidney disease.