Reduced glomerular filtration rate and albuminuria do not account for the total risk of developing end-stage renal disease (ESRD), suggesting that other factors might be involved in progressive renal function worsening. Among these, cardiovascular disease, even subclinical, could play a role. The role of left ventricular hypertrophy in this setting is reviewed in light of recent reports that showed that it is associated with faster progression of renal disease to ESRD requiring dialysis, in both hypertensive and chronic kidney disease patients.