Chronic kidney disease (CKD) is an independent risk factor for coronary artery 
disease (CAD). Coronary artery disease is the leading cause of morbidity and 
mortality in patients with CKD. The outcomes of CAD are poorer in patients with 
CKD. In addition to traditional risk factors, several uremia-related risk 
factors such as inflammation, oxidative stress, endothelial dysfunction, 
coronary artery calcification, hyperhomocysteinemia, and immunosuppressants have 
been associated with accelerated atherosclerosis. A number of uremia-related 
biomarkers are identified as predictors of cardiac outcomes in CKD patients. The 
symptoms of CAD may not be typical in patients with CKD. Both dobutamine stress 
echocardiography and radionuclide myocardial perfusion imaging have moderate 
sensitivity and specificity in detecting obstructive CAD in CKD patients. 
Invasive coronary angiography carries a risk of contrast nephropathy in patients 
with advanced CKD. It should be reserved for those patients with a high risk for 
CAD and those who would benefit from revascularization. Guideline-recommended 
therapies are, in general, underutilized in renal patients. Medical therapy 
should be considered the initial strategy for clinically stable CAD. The effects 
of statins in patients with advanced CKD have been neutral despite a 
lipid-lowering effect. Compared to non-CKD population, percutaneous coronary 
intervention (PCI) is associated with higher procedure complications, 
restenosis, and future cardiac events even in the drug-eluting stent era in 
patients with CKD. Compared with PCI, coronary artery bypass grafting (CABG) 
reduces repeat revascularizations but is associated with significant 
perioperative morbidity and mortality. Screening for CAD is an important part of 
preoperative evaluation for kidney transplant candidates.