Ischemic heart disease is the major cause of death in dialysis patients. Efforts at coronary artery disease detection in end-stage renal disease patients have primarily focused on the cardiac evaluation of 'high-risk' renal transplant candidates. Despite their high cardiac risk, no data exist on the results of reperfusion therapy in dialysis patients with acute myocardial infarction, and the outcome of coronary revascularization procedures remains controversial. This review highlights recent work on the diagnosis and treatment of coronary artery disease in dialysis patients.