Improving patient safety has become a primary objective of health systems; however, the frequency of adverse safety events continues to be unacceptable despite the attention and dedicated efforts of many stakeholders. CKD that does not require dialysis increases the risk for adverse safety events, and adverse safety events can account for a substantial portion of the poor outcomes typical of CKD. Because much of CKD care occurs outside the typical health care setting, systems designed to detect and reduce adverse safety events are not necessarily effective in this population. Underrecognition (or underappreciation) of CKD and the associated impairment of renal function contribute to the high risk for adverse safety events. Medication errors are common in CKD and account for many lapses in patient safety, but a wide range of other potentially modifiable care processes in CKD also contribute to the high rate of observed adverse safety events. This review describes the spectrum of safety concerns specific to CKD and the need for a common set of standards to improve on current general constructs and to reduce adverse safety events in this chronic disease. An accepted set of disease-specific indicators is necessary to gauge the extent of the disease-specific patient safety problem and to design means to reduce adverse safety events and improve outcomes in CKD.