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Cardiovascular disease is prevalent in the ESRD and CKD population. Accounting for 39% of deaths among dialysis patients, death from cardiovascular disease is more common in CKD patients than their progression to ESRD. While kidney disease and heart disease have similar causal factors, unique properties of the renal patient’s physiology also impose higher cardiac risk. Such factors as inflammation, oxidative stress, uremia, and metabolic abnormalities contribute to higher coronary artery disease incidence and mortality. Diagnosis of cardiac disease can be more difficult in this patient population. Typical ECG findings of ischemia may be subtle due to baseline ECGs with underlying left ventricular hypertrophy and acute changes related to electrolyte disorders or fluid overload. When present, though, classic ST‐segment changes indicative of acute coronary syndrome are the same in the ESRD patient as the nondialysis patient [18,19].

Stroke is also more common in renal disease patients than the general population. The risk is increased in patients with more advanced CKD, and even higher rates of stroke exist in the first year after dialysis begins. Both hemodialysis and peritoneal dialysis carry elevated stroke risks, although incidence may be slightly lower for the latter [20].