The prevalence of coronary artery disease (CAD) appears to be much higher in patients with end-stage renal disease (ESRD) undergoing dialysis than in a non-ESRD population. Cardiac death due to myocardial ischemia significantly contributes to the high mortality rate of ESRD patients. However, the method for screening for CAD in ESRD patients has not been established, because the frequency of silent myocardial ischemia is high and examinations requiring stress are often difficult to perform among this population. Myocardial fatty acid imaging may be a new modality to detect myocardial ischemia and identify the group at high risk for cardiac death among ESRD patients without adding any stress.