Background: Cardiovascular complications in children with chronic kidney disease (CKD) present significant clinical challenges. As kidney function declines, particularly in those with advanced stages or on maintenance dialysis, children become increasingly vulnerable to cardiovascular disease (CVD). These patients often have a higher burden of both traditional risk factors—such as hypertension and dyslipidemia and uremia-related factors, including fluid overload, mineral bone disease, and anemia. Early signs of cardiomyopathy and atherosclerosis, such as left ventricular dysfunction, are commonly observed in these young patients. Aim: This research seeks to explore the causes and impacts of cardiovascular disease in children living with chronic renal disease in Al Qalyubia Governorate. Understanding these factors is crucial for improving early detection, prevention, and management strategies for this vulnerable population. Conclusion: Cardiovascular disease is the leading cause of mortality in children with end-stage renal disease (ESRD). The pathophysiology of cardiovascular complications in CKD involves multiple factors, including hypertension, fluid imbalance, mineral metabolism disorders, and anemia. Early identification and proactive management of these risk factors, especially in the early stages of CKD, are critical to improving outcomes. Kidney transplantation remains the most effective long-term solution to avoid the complications associated with dialysis. However, even post-transplant, ongoing monitoring and management are essential, as cardiovascular risk persists. Careful control of modifiable risk factors, including blood pressure and lipid levels, is necessary to optimize long-term health and survival in these patients.