Cardivascular diseases are the leading cause of death among patients with end-stage renal disease. Chronic renal failure is not only a known risk factor for commonly seen cardiovascular diseases such as coronary heart disease and left ventricular hypertrophy, but also for some other diseases related to the cardiovascular system such as pericarditis, infective endocarditis, and arrhythmias. Many other diseases that frequently accompany chronic renal failure such as systemic hypertension, hyperlipidemia, homocysteinemia, and hyperparathyroidism contribute to the development of cardiovascular risks. It should be realized that ischemic heart disease may have varying aspects in renal failure with regard to pathophysiology, clinical presentation, and diagnosis. Although treatment approach in these patients is similar to that in general population, dose adjustment of drugs needs special consideration. While chronic renal failure adversely affects the cardiovascular system, it should be noted that heart failure may also have adverse effects on renal functions, most importantly by means of prerenal azotemia. Recently, nephropathy due to radiocontrast dye use in coronary interventions has drawn considerable attention to the relations between these two systems. This review focuses on interactions between renal diseases and the cardiovascular system together with the ensuing detrimental effects and their prevention.