Aim To investigate the correlation between serum leptin level and intima-media thickness of carotid artery in chronic kidney disease patients (CKD). Methods Seventy-nine non-dialytic CKD patients and fifteen healthy volunteers were involved in the study. CKD patients were classified into three groups according to glomerular filtration rate (GFR):CKD 2～3 stage,CKD 4 stage and CKD 5 stage,the serum leptin was tested by the radio-immunity method; Intima-medial thickness (IMT) of carotid artery and the presence of atherosclerotic plaques were determined by using noninvasive high-resolution B-mode ultrasonography. Results Sermu leptin,IMT and prevalence of atherosclerotic plaques in CKD patients were significantly higher than those in healthy groups (P><0.01). The serum leptin and CRP concentrations were significantly increased in CKD patients with atherosclerosis of carotid artery group (17.06±1.06 ng/L vs 14.27±0.70 ng/L;P><0.05),(3.32±0.19 mg/L vs 2.55±0.17 mg/L;P><0.01). The linear correlation analysis indicated the serum leptin was correlated positively with urea nitrogen,serum creatinine,C-reaction and body mass index (r=0.293,P><0.01,r=0.324,P><0.01;r=0.539,P><0.01;r=0.312,P><0.05). The serum leptin level was correlated negatively with glomerular filtration rate,hemoglobin and albumin (r=-0.389,P><0.01;r=-0.454,P><0.01;r=-0.246,P><0.05). Logistic regression analysis further indicated that Leptin (β=1.527,P><0.05) was an independent risk factor of atherosclerosis in non-dialytic CKD patients. Conclusion The patients of CKD exist hyperleptinemia. The serum leptin was significantly correlated with IMT. Hyperleptinemia was an independent risk factor and might play a role in pathogenesis and progression of atherosclerosis.