C-reactive protein (CRP) is considered to be the prototype marker of inflammation. In the general population, there are ample clinical and epidemiological data that indicate its usefulness both in predicting the prognosis for various forms of cardiovascular disease, and in monitoring response to treatment. There is also evolving evidence that CRP may be directly involved in the pathological disease process itself. In end-stage renal disease (ESRD) patients, cardiovascular disease remains the leading cause of morbidity and mortality, and is accounted for by a clustering of both traditional and non-traditional risk factors. Of these, inflammation is considered one of the important risk factors and is usually denoted by the presence of elevated CRP. However, since it is a non-specific inflammatory marker and acute-phase reactant, CRP may become elevated as a result of other dialysis-related (such as graft and fistula infections, bio-incompatible dialysis membrane or dialysate, endotoxin exposure and back filtration) and dialysis-unrelated factors (such as chronic infections and malnutrition). This raises an important question as to whether CRP serves as a useful prognostic biomarker in the dialysis population. This review provides an updated view of the use of CRP as a prognostic marker of cardiovascular disease in ESRD patients on maintenance dialysis.