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Multiple mechanisms contribute to this close relationship, including 18,19 : Endothelial dysfunction Volume overload and salt retention Overactivity of the sympathetic (fight-or-flight) nervous system Adverse changes in the hormonal regulation of blood pressure Dysfunction of the renin-angiotensin-aldosterone system Ultimately, in people with CKD and diabetes, kidney tissue and blood vessels are much more sensitive to pressure damage than those with uncomplicated mild-to-moderate high blood pressure