Illustration representing a longitudinal section of a vascular vessel. In CKD, toxins and cytokines are present in the circulation. RRTs, although necessary, contribute to activate circulating blood cells with the release of cytokines that enrich the toxic environment. Chronic inflammation and oxidative stress coexist with endothelial dysfunction in CKD. The hematocrit is decreased because of the anemia. Activated platelets circulate and form heterotypic aggregates with monocytes. Platelet hyperactivity contributes to thrombus formation. From Yang et al, the uremic toxin indoxyl sulfate seems to play a crucial role in the activation of these processes, and Klotho protein could be a promising strategy to prevent them.