Most of the recent advances in the understanding of chronic kidney disease (CKD)-related cardiovascular disease have focused on atherosclerosis and arteriosclerosis, and much less effort has been dedicated to unveil and evaluate the mechanisms and impact of interventions related to myocardial dysfunction. Hence, echocardiographic evaluation plays a pivotal role in establishing the diagnosis of myocardiopathy as well as in stratifying risk and defining the impact of interventions. The aim of this review is to examine the profile of myocardiopathy in CKD, and to identify how the echocardiogram can be useful in diagnostic and prognostic clinical approaches.