Increased frequencies of peptic ulcer disease (PUD) and gastroesophageal reflux disease (GERD) have been described in uremic patients, with significantly higher complication, morbidity and mortality rates. The underlying etiopathogenetic mechanisms are still not clearly elucidated, although different causative factors, peculiar to chronic kidney disease (CKD), might play an important role. Several surgical strategies have been proposed for the elective management of PUD in cases of intolerance to medical treatment or disease recurrence. Among them, truncal vagotomy and antrectomy represents the procedure of choice, owing to the lower recurrence rates. In small (<2 cm) perforated peptic ulcers (PPUs), laparoscopic primary repair is considered the standard treatment, whereas in large PPUs (>2 cm), the approach should be tailored to the ulcer’s location and the patient’s condition. In the presence of PUD-related bleeding, surgical hemostasis or angiographic embolization are indicated after unsuccessful endoscopy. In symptomatic GERD, laparoscopic fundoplication represents the mainstay of treatment, with the best results achieved by the Nissen technique. Robot-assisted antireflux surgery is emerging as a safe and feasible method, with comparable outcomes. Other minimally invasive methods, including laparoscopy-assisted magnetic sphincter augmentation and endoscopic transoral incisionless fundoplication, have recently been described and validated by meta-analyses supporting their appropriateness, mainly in poor surgical candidates.