Despite substantial progress in dialysis patients' management, cardiovascular disease remains the major cause of death. Nearly half of deaths on dialysis are secondary to myocardial infarction, cardiac arrest, malignant arrhythmias and other cardiac causes. The high prevalence of diabetes, anemia, hyperparathyroidism and hypertension among chronic dialysis patients fosters structural heart diseases. Moreover, fluid overload and metabolic abnormalities such as metabolic acidosis, dyskalemia and dysmagnesemia lead to an increased risk of clinically significant arrhythmias and sudden cardiac death. End-stage renal disease (ESRD) is often characterized by the presence of sympathetic hyperactivity and activation of the renin-angiotensin-aldosterone system (RAAS). Control of sympathetic outflow, blockade of the RAAS and prevention of electrolyte disorders should be the mainstay of cardiovascular prevention in ESRD patients. This review summarizes the current available literature regarding the epidemiology of arrhythmias in dialysis patients, the underlying mechanism of atrial fibrillation or sudden death and potential interventions to reduce the risk of arrhythmias in dialysis patients, including medical therapy or defibrillators.