Chronic kidney disease (CKD) remains a major health problem of which the prevalence is estimated between 11 to 13%. Cardiovascular disease (CVD) is the major cause of death in CKD patients. Traditional risk factors insufficiently explain the high risk for CVD in CKD, while non-traditional risk factors (uraemic toxins, inflammation, endothelial dysfunction…) seem to play a far more important role. Accumulation of specific uraemic toxins is associated with the increased risk for CVD in CKD and depends on the balance between kidney elimination, which progressively decreases during the course of CKD, generation and absorption. A substantial part of this generation/absorption process is regulated in the intestine. Addressing the gut microbiota and their functional capacity and of the gut barrier function, trying to decrease levels of these toxins and so improving the (CV) outcome of CKD patients, could lead to cost effective interventions which need to be explored.