In non-diabetic patients with (primary) kidney diseases a syndrome of insulin resistance can be diagnosed even before the onset of impaired renal function and uremia. It is presenting with hyperinsulinemia, glucose intolerance, hyperglycemia and dyslipidemia. As a result, patients with kidney diseases own the same metabolic cardiovascular risk factors as patient with the classic metabolic syndrome. Thus, this renal insulin resistance syndrome may not only contribute to the excessive cardiovascular risk of patients with kidney diseases, but may also help to explain why even a minor impairment of renal function is a significant and independent cardiovascular risk factor in the general population.