We examined the records of 101 Japanese patients with chronic renal failure (CRF) to determine the influence of established risk factors on the incidence of coronary artery disease (CAD). CAD was found in 25 patients (myocardial infarction in 18, significant coronary artery stenosis by coronary angiogram in 16). In patients with CAD, there were significantly more male (80% vs 58%, p < 0.05), more smokers (80% vs 41%, p < 0.0005), more diabetics (68% vs 32%, p < 0.005) and more hypertensives (92% vs 76%, p < 0.05). However, lipoprotein (a), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, or triglycerides were not significantly different between CAD group and control group. When significant risk factors were entered into a stepwise logistic regression analysis, we found a history of smoking (p = 0.0025) and the presence of diabetes (p = 0.0141) to be independent risk factors for the presence of CAD in Japanese patients with CRF.