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T cell populations in CKD exhibit a shift toward pro-inflammatory phenotypes, with reduced regulatory T cell function, which fails to suppress excessive immune responses, thereby sustaining inflammation and tissue injury ( FIGURE 2 Dysbiosis of the gut microbiota leads to the disruption of tryptophan metabolism (resulting in the production of toxins such as IS and the entry of lipopolysaccharides (LPS) into the bloodstream ( 4 Immune mechanisms in CKD-MBD Chronic kidney disease-mineral and bone disorder is a systemic condition marked by disruptions in mineral metabolism, bone pathology, and VC, intricately linked to immune dysregulation