Coronary artery disease is a frequent condition in dialysis patients and – probably due to the atypical symptomatology – is frequently underdiagnosed. Non-invasive tests are of limited value in establishing diagnosis, whereby arteriography is frequently necessary. Secondary prophylaxis is the same as in nondialysis patients. Due to a high reocclusion rate following PTCA bypass grafting is the preferred therapeutical option. When medical therapy is indicated, hemodialysis therapy should be adapted to coexistent coronary artery disease by avoiding dialysis hypotension and overhydration. In coronary patients renal anemia worsens coronary perfusions and should be treated targeting at least a hematocrit of 35 %.