This chapter discusses about cardiac evaluation during kidney transplantation, where the cardiovascular system is affected in patients with chronic kidney disease (CKD), leading to significant morbidity and mortality. Chronic kidney disease has been strongly associated with MI. The combination of disease of both these vital organs becomes particularly problematic in this patient group, enhancing their mortality risk in the event of a MI. Blood pressure should be well-controlled for prevention of cardiovascular events and death. Ensure optimal lipid control for primary prevention of cardiovascular events and death through diet, statins, and or fibrates. Asymptomatic patients should be seen on an annual basis after initial evaluation to monitor for CVD whilst on the waiting list. Cardiac evaluation should be revisited sooner if a patient develops symptoms suggestive of ischemic heart disease or heart failure. Patients with structural heart disease including valvular disorders need to be evaluated appropriately and based on severity treated accordingly.