Accumulation of larger middle molecules, pro-inflammatory cytokines such as interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α), and free light chains (FLCs) promotes chronic inflammation [4], endothelial dysfunction and vascular calcification [5], and protein-energy wasting, all of which exacerbate symptom burden and heighten cardiovascular risk [6]. This evidence concerns the gene TNF and endothelial dysfunction.