Patients with uremia have a higher risk of developing cancers and a worse prognosis compared to the general population. Ductal adenocarcinoma of the pancreas, commonly referred to as pancreatic cancer (PC), is associated with a poor prognosis. Statistical projections predict an increase in PC incidence, with the disease expected to become the second leading cause of cancer-related death by 2030. While the modern management of PC relies heavily on multimodal treatment, surgery remains the only therapeutic option that consistently prolongs survival and offers a potential chance for cure. However, pancreatic resections—particularly pancreatoduodenectomy—are among the most challenging surgical procedures and are associated with high complication and postoperative mortality rates. These risks are further amplified in uremic patients, as chronic kidney disease (CKD) is linked to multiple comorbidities that increase perioperative risks and complicate patient management. As a result, patients with CKD and PC are rarely selected for pancreatic resection. The available data on this topic primarily come from single-center, retrospective studies. In this chapter, we review the literature on the incidence of PC in the uremic population, as well as the implications of CKD on perioperative management and short- and long-term outcomes.