Although there is no doubt that patients with CKD are subject to accelerated atherosclerosis the major pathological features of the cardiovascular system in CKD are myocardial disease (so called uraemic cardiomyopathy) and arterial stiffening due to arteriosclerosis. As kidney function declines, a range of abnormalities occur that may exert adverse effects upon the cardiovascular system. Hypertension, chronic anaemia, oxidative stress, inflammation and activation of the renin-angiotensin-aldosterone (RAAS) and sympathetic nervous systems all appear to contribute to the development of atherosclerosis, arteriosclerosis and myocardial hypertrophy and fibrosis.