The prevalence of chronic kidney disease (CKD) in the United States’ population 20 years of age and older is about 11% in men and 15% in women. In 2008 it was estimated that more than 28 million people had CKD. This population is considered to be the “highest risk group” for subsequent cardiovascular disease (CVD) events. The cardiovascular morbidity and mortality rates sharply rise with a drop in kidney function and are particularly high in dialysis patients. Etiology of the increased risk is not completely understood and possible explanations include the high prevalence of traditional risk factors, as well as the so-called non-traditional risk factors specific for the CKD population. In the setting of decreased kidney function, the cardiovascular system is exposed to a number of unique abnormalities leading to unique differences in the presentation, diagnosis and management of CVD in the CKD population. Faced with the escalating numbers of CKD patients worldwide, it is of paramount importance to improve the understanding, early recognition, and development of new treatment strategies for CVD in the CKD population.