Arterial stiffness as measured by aortic pulse wave velocity (aPWV) and augmentation index (AIx), is a surrogate marker of cardiovascular organ damage, and is signiﬁcantly associated with the future risk of clinical events. In addition, some studies have demonstrated that aPWV is an independent and powerful predictor of all-cause and cardiovascular mortality in patients on dialysis. Reduction of aPWV, mainly by use of an ACE-inhibitor, is associated with an improved survival in dialysis patients. These findings suggest that arterial stiffness is not merely a marker of arterial damage but a potentially reversible factor contributing to mortality in dialysis patients. There is strong cross-sectional evidence that arterial stiffness increases as glomerular filtration rate (GFR) falls. In the general population, among treated hypertensives, even minimally impaired baseline renal function (serum creatinine >90μmol/l) is associated with an increased rate of aortic stiffening. Conversely, arterial stiffness has also been established in a number of studies as a significant risk factor for CKD progression.