The central hypothesis in cardiorenal medicine is that the heart and the kidneys are inectricably linked in terms of regulation, function, and the preservation of health and unfortutunately, in the progression of disease. This chapter will lay out the evidence base for chronic kidney disease (CKD) acting as a cardiovascular risk state. This implies that CKD is more than a risk factor for heart disease, but a pervasive problem that is multifaceted. The four major domains of cardiovascular disease will be addressed with respect to CKD and its contributions: atherosclerosis, myocardial disease, valvular disease, and arrhythmias.