Cardiorenal syndrome is an umbrella term describing the range of interactions between the heart and kidneys. Commonly, this focuses on the potential for reduced renal function as a consequence of heart disease and the impact of reduced renal functional reserve on the heart. Importantly, these interactions include both consequences of the disease state and those arising from therapeutic interventions directed at the cardiorenal axis. This article focuses on the potential impact of dialysis treatment, which generates intermittent circulatory stress and results in both acute and chronic adverse cardiovascular effects. This largely unappreciated dimension of the cardiorenal interaction in patients with end-stage renal failure is common, associated with a significant increase in mortality, and may be amenable to a variety of therapeutic approaches in this population characterized by particularly significant clinical management challenges.