Aim To explore the relationship of serum zinc, copper, copper/zinc ratio and coronary artery calcification (CAC) in patients with chronic kidney disease. Methods Using the cross-sectional analysis method, 274 patients with chronic kidney disease were studied. According to the coronary artery calcification scores, the patients were divided into calcified group and non-calcified group, and the clinical data and laboratory indicators of the two groups were compared. Spearman correlation analysis was used to analyze CAC related factors, binary Logistic regression was used to analyze CAC risk factors, and ROC curve was used to explore the predictive value of zinc, copper, and copper/zinc ratio on CAC. Results The serum zinc level of calcified group ((77.09±15.84) μmol/L) was lower than that of non-calcified group ((88.21±11.55) μmol/L). Serum copper ((13.99±3.76) μmol/L) and copper/zinc ratio (0.19±0.08) were higher in calcified group than those of non-calcified group ((12.10±3.99) μmol/L, (0.14±0.05)). Spearman correlation analysis showed that serum zinc level (r＝－0.387, P＜0.001) was negatively correlated with coronary artery calcification scores (CACS). Serum copper(r＝0.356, P＜0.001) and copper/zinc ratio (r＝0.477, P＜0.001) were positively correlated with CACS. Binary Logistic regression analysis showed age (OR＝1.085, P＜0.001), serum copper (OR＝1.114,P＜0.001) and copper/zinc ratio (OR＝1.143, P＜0.001) were risk factors for CAC. And serum zinc (OR＝0.948, P＜0.001) was protective factor for CAC. ROC curve analysis showed that the AUC of zinc, copper, and copper/zinc ratio were 0.1,0.0,0.716 in predicting CAC (P＜0.001). Conclusion Patients with chronic kidney disease with high age, high levels of copper and copper/zinc ratio, and low zinc have higher risk of CAC, and the copper/zinc ratio has better predictive value for the occurrence of CAC.