**4.1 From system biocompatibility to systemic chronic inflammation**

The concept that inflammation underlines many diseases once considered to be linked to degenerative processes has revolutionized the approach to the research into the pathogenesis and new therapeutics alike. In the field of cardiovascular disease, the process of endothelial dysfunction, vascular damage and atherosclerosis is now seen as a continuum (Libby et al., 2002). Cardiovascular disease is among the leading cause of morbidity and mortality in CKD patients on maintenance HD (US Renal Data System, 1997; Parfey & Foley, 1999). Even before reaching the state of chronic kidney disease Stage 5, patients with chronic renal failure present signs of chronic inflammation. Once patients are on HD, the risk of cardiovascular death is approximately 30 times higher than in the general population, and still remains 10 to 20 times higher after stratification for age, gender, and presence of diabetes. Traditional risk factors seem inadequate to explain the remarkable prevalence of cardiovascular disease observed in the uremic population (Foley et al 1998).
