The risk of cardiovascular disease in patients with chronic renal disease appears to be far greater than in the general population. For example, among patients treated by hemodialysis or peritoneal dialysis, the prevalence of coronary artery disease is approximately 40% and the prevalence of left ventricular hypertrophy is approximately 75%. Cardiovascular mortality has been estimated to be approximately 9% per year. Even after stratification by age, gender, race, and the presence or absence of diabetes, cardiovascular mortality in dialysis patients is 10 to 20 times higher than in the general population. Patients with chronic renal disease should be considered in the highest risk group for subsequent cardiovascular events. Cardiac failure is more common in chronic renal disease patients than in the general population, and is an independent predictor of death in chronic renal disease. Among hemodialysis and peritoneal dialysis patients, the prevalence of cardiac failure is approximately 40%. Both coronary artery disease and left ventricular hypertrophy are risk factors for the development of cardiac failure. In practice, it is difficult to determine whether cardiac failure reflects left ventricular dysfunction or extracellular fluid volume overload. Patients who develop clinical manifestations of cardiac failure should be evaluated for cardiovascular disease.