The Nestor of chronic dialysis, Belding Scribner, was well aware of most problems which plague hemodialysis to this day, but the major problem we are confronted with today has emerged much later, i.e. excessive cardiovascular mortality. Apart from modulating duration and frequency of dialysis, there is currently no logistic or technological solution immediately apparent to solve this problem. Elucidating and correcting the cardiovascular risk is the most important challenge to clinical nephrology today.