Patients with end-stage renal disease have a high risk of cardiovascular events, and are often referred for non-invasive screening prior to kidney transplantation. Several European and North American professional organizations have issued guidelines on what tests to perform and which patients may benefit most from them. There is some discrepancy between the various guidelines and their application varies broadly across medical centers and countries. In this review, we briefly discuss the advantages and disadvantages of the non-invasive imaging methodologies that can be used to risk stratify patients prior to transplant. We conclude by offering some practical recommendations on how to approach risk stratification in this population of patients.