Cardiovascular disease is the leading cause of death in Western countries and it is especially frequent in dialysis patients. Although for a long time physicians have been mainly focused on the severity of luminal coronary stenosis, atherosclerosis starts and expands in the thickness of the arterial wall much before it extends into the vessel lumen. Indeed, most acute coronary events occur in patients with non-obstructive luminal disease. On pathologic examination, patients with end-stage renal disease (ESRD) show larger and more extensively calcified atherosclerotic lesions than non-dialysis patients. Recent evidence shows that even very young dialysis patients show premature calcification of the coronary arteries. Therefore, early detection of atherosclerotic disease with a non-invasive imaging technology, such as electron beam tomography (EBT), may provide an opportunity to modify the disease course and reduce the related event rate.