Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular events including atherosclerosis-related complications. In uremic patients, increased serum phosphate concentration is a significant risk factor for vascular calcification. a cross-sectional study included 90 CKD adult patients, using B-mode ultrasonography, we examined intima-medial thickness (IMT) of the carotid artery of patients and analyzed risk factors for increased IMT. 24 h urinary phosphate excretion (mg/day) and creatinine clearance was calculated. The study cohort included ninety CKD patients. Carotid intima media thickness (cIMT) of patients increased significantly with progression of CKD P=0.001. Mean cIMT showed significant positive correlation with duration of hypertension, uric acid, serum phosphorus, PTH& fraction excretion of phosphorus (FeP) (r .365; p .001, r .380; p .000, r .376**p .000, r .422; p .000 & r .268; p .011) respectively. While calcium & CKD-epi negatively correlated significantly with mean cIMT (r -.255; p .015 & r-.421; p.000 respectively). linear regression analysis showed higher FeP was associated with higher PTH levels as well as higher FGF23 levels. negative correlation was seen between measured GFR and FeP (r -0.365, p = 0.000). The cIMT is early marker for atherosclerosis.it was significantly higher in patients with advanced CKD. increased serum phosphorus, PTH& fraction excretion of phosphorus are risk factors for increased CIMT in patients with CKD.