Children with chronic kidney disease (CKD) face lifelong chronic illness in which risks to cardiovascular (CV) health begin early in the course of the disease, and by the time these children reach young adulthood, their risk for death from CV disease is 30-fold higher compared with their healthy peers.1 In this issue of AJKD, Brady et al2 explore the differential role of sex in determining harmful effects of obesity on CV outcomes in children with CKD. Although it is widely known that obesity adversely affects CV risk in general, this interesting study adds further dimensions to our understanding by illuminating how these adverse effects may be modified by sex.