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Coagulation anomalies, endothelial dysfunction, and aortic stiffness. In chronic kidney disease, the arterial wall undergoes complex remodeling, which leads to aortic stiffness. This causes increased cardiac workload and enhanced pulse pressure transmission into microcirculation, leading to microvascular damage and organ dysfunction. Beyond regulation of vascular tone, endothelium plays a key role in coagulation. In hemodialysis patients, Tran et al. show that the ongoing coagulation activity is associated with aortic stiffness. In contrast, anticoagulant factors are increased, explaining reduced endogenous thrombin potential and the increased bleeding risk.