Adrenal disease (AD) in patients with chronic kidney disease (CKD) is rare. Diagnosis may be very difficult: there are overlapping symptoms between CKD and AD, while urinary hormone excess tests are not available in hemodialysis (HD) patients. Adrenal surgery in CKD is feasible and effective but requires assessment and prevention of specific perioperative risks. Breast cancer (BC) is the most diagnosed cancer among women. There is an increased risk of BC and higher mortality from BC in HD patients. Although the occurrence of combined CKD and BC among these patients is rare, it poses a significant challenge for BC treatment. Surgery, radiation, and systemic therapies are the mainstay of BC treatment. Systemic therapies include chemotherapy, hormone and anti-HER2 therapy, CDK4/6 and PARP inhibitors. HD does not limit the utility of surgical treatment and radiotherapy. A customized strategy for systemic therapy is crucial for optimizing patient outcomes while minimizing potential risks in the CKD population.