Arterial blood pressure normally displays diurnal variation, characterized by dipping pattern around 3 a.m. and two daytime peaks (9 a.m. and 7 p.m.). The blood pressure during the nighttime mean is normally 10-20% lower compared to the daytime mean. Disrupted circadian rhythm of blood pressure is frequently seen within the patients with chronic kidney disease and often result in high cardiovascular morbidity and mortality. There are several mechanisms underlying disruption of blood pressure circadian rhythm in the patients with chronic kidney disease. Firstly, decreased glomerular filtration rate and increased sodium reabsorption results in increased pressure-natriuresis and elevated nocturnal blood pressure. People with high-sodium sensitivity have a diminished nocturnal blood pressure fall. Second, sleep disturbance may lead to non-dipper pattern of nighttime blood pressure. Sleep apnea may exacerbate night-time blood pressure elevation and increased heart rate during sleep. Third, the circadian variation of autonomic nervous system is altered in the patients with chronic kidney disease. The sympathetic nervous system is activated throughout nighttime, which leads to decreased blood pressure difference between daytime and nighttime. Fourth, the patients with chronic kidney disease exhibit reduced vasodilation. Use of erythropoietin-stimulating agents for anemia correction and secondary hyperparathyroidism both cause vasoconstriction. Uremia itself impairs vasodilation by inhibiting nitric oxide synthase. Finally, the intrarenal renin-angiotensin- aldosterone system, the most important hormonal system for blood pressure homeostasis, is activated in the patients with chronic kidney disease. Urinary angiotensinogen levels are significantly higher during the daytime in the patients with chronic kidney disease. The renal proximal tubular angiotensinogen is found to be significantly higher in non-dippers than dippers and correlate with the night-to-day ratio of blood pressure. In addition, the level of angiotensin II, the major effector hormone, is elevated both during daytime and nighttime in the patients with chronic kidney disease. Understanding pathophysiology of disrupted circadian rhythm of blood pressure in the patients with chronic kidney disease is important to diagnose and treat hypertension. Utilization of 24-hour monitoring of ambulatory blood pressure or home blood pressure should be considered to diagnose non-dipping pattern of blood pressure. A long half-life anti-hypertensive agent or twice daily prescription should be considered to adequately treat hypertension in non-dipper patients.