Patients with end stage renal disease are at an increased risk for cardiovascular disease (CVD) and the annual mortality from CVD in end-stage renal disease (ESRD) patients is substantially higher than in the general population. Peripheral arterial disease (PAD), the most common manifestation of atherosclerosis, is characterized by atherosclerotic occlusive disease of the lower extremities. The most common symptom of PAD is intermittent claudication, defined as pain, cramping, or aching in the calves, thighs, or buttocks. However, it has been reported that over one-half of those with PAD remains asymptomatic. Rest pain, tissue loss, and gangrene are among the more extreme presentations of PAD and PAD has been a major cause for lower-extremity amputation, especially in those HD patients with diabetes. However, few available data stressed on the huge burden of PAD in hemodialysis (HD) patients. More importantly, presence of PAD in these patients is an important predictor for subsequent cardiovascular and overall mortality. The medical therapy of in PAD in general population is limited to a few antiplatelet drugs and statin in relatively few descriptive studies and randomized control trials. There are no appropriate randomized trials of these therapies in the treatment of PAD in patients with chronic kidney diseases. Hence, there are as yet no substantial data to support for efficacy of pharmacologic interventions of PAD in these specific groups of patients.