Chronic kidney disease (CKD) and peripheral arterial disease (PAD) are common and frequently coexist. Among subjects with CKD, arterial disease may be due to atherosclerosis, medial arterial calcification (MAC), or both conditions concomitantly. It is important for clinicians to recognize both conditions because each identifies individuals at higher risk of cardiovascular disease events, and because the presence of MAC complicates interpretation of the ankle brachial index, the most commonly used diagnostic test for artherosclerotic PAD. To that end, we review the epidemiology and diagnosis of atherosclerotic PAD and medical arterial calcification in patients with CKD.