Proposed mechanisms include shared risk factors such as hypertension (HTN) and diabetes.1,3,4 Inflammation, volume overload, anemia, oxidative stress, and upregulation of the renin-angiotensin-aldosterone system and sympathetic nervous system also contribute to HF pathogenesis.1,3,4 These factors explain some, but not all, of the heightened HF risk in patients with CKD. Here, REN is linked to hydrops fetalis.