Figure 4 The gut–kidney axis, inflammation and cardiovascular disease in CKD Figure 4 | The gut–kidney axis, inflammation and cardiovascular disease in CKD. Aswell as causing the retention of uraemic toxins (including toxins generated in the intestinal system), chronic kidney disease (CKD) alters the integrity of the intestinal barrier, which leads to translocation of intestinal microbiota into the blood, systemic inflammation, increased absorption of uraemic toxins from the intestine and cardiovascular disease. Uraemic toxins are strong proinflammatory stimuli. Cardiovascular disease also contributes to alter the intestinal barrier via venous intestinal congestion secondary to heart failure. Zoccali, C. et al. (2017) The systemic nature of CKD Nat. Rev. Nephrol. doi:10.1038/nrneph.2017.52