Figure 2. The ‘iceberg delusion’ may prevent appreciation of the magnitude of CVD in CKD patients.

Most of the vast endothelial surface area is part of the microcirculation. Considering the entire vasculature, CKD affects first and foremost the microcirculation in a silent, subclinical process. When macrovascular involvement and CVD events appear on the clinical horizon, these late events can be viewed as the tip of the iceberg of CKD-induced vascular disease.