Objectives: Impaired renal function and metabolic syndrome have been associated with risk of cardiovascular disease ( CVD). We investigated their roles in CVD and all-cause death among ethnic Chinese population. Methods: We followed up a cohort of 11429 men and 7472 women aged 20 years and older for an average 4.9 years (median: 3.5, inter-quartile range: 2. 7-7.9) from the tertiary hospital health check-up population. Results: CVD death rates increased when the quintiles of each variable progressed. Metabolic syndrome was a significant predictor for CVD death, with relative risk of up to 4.68. In the multivariate adjusted model that included metabolic syndrome, quintiles of serum creatinine concentrations, estimated glomerular filtration rate (GFR), and uric acids were significantly associated CVD death, with the highest relative risk of creatinine concentration (11. 22, 95% confidence interval [CI]: 2.43-51.7, P for trend: