Chronic kidney disease (CKD) significantly amplifies cardiovascular risk through mechanisms involving blood pressure (BP), circadian variability, and metabolic disturbances. This chapter explores how these factors contribute to the heightened cardiovascular morbidity and mortality observed in CKD patients. Abnormal BP circadian patterns, such as non-dipping/nocturnal hypertension, alongside increased short-term or long-term visit-to-visit variability, are prevalent in CKD and are strong predictors of adverse cardiovascular events. The utilization of ambulatory blood pressure monitoring (ABPM) is emphasized for the accurate detection and management of these BP anomalies. Furthermore, CKD-related metabolic disturbances, including dysregulation of bone-mineral metabolism, dyslipidemia, protein-energy wasting syndrome, and electrolyte imbalances, play a crucial role in the progression of cardiovascular disease. These metabolic disruptions lead to vascular calcifications, systemic inflammation, and oxidative stress, further complicating the cardiovascular profile of CKD patients. Effective management strategies require a comprehensive approach that integrates BP monitoring and tailored therapeutic interventions to address these metabolic abnormalities. Future research should focus on the mechanistic links between BP variability, metabolic disturbances, and cardiovascular outcomes to develop predictive tools for better clinical management. This chapter underscores the necessity of a multifaceted approach to mitigate cardiovascular risks and improve the quality of life for CKD patients.