<i>Background/Aims:</i> Carotid intima-media thickness (IMT) assessed using ultrasonography is a widely used marker of atherosclerosis. In the largest study to date of IMT and chronic kidney disease (CKD), we assessed correlates of IMT in CKD patients with a wide range of renal dysfunction, and also investigated what happens to IMT following renal transplantation. <i>Methods:</i> We studied 406 patients with different stages of nondiabetic CKD (50% males, 46 ± 12 years), and 58 kidney transplant recipients (27 ± 6 years), testing relationships between IMT, assessed by ultrasonography, and selected biomarkers. <i>Results:</i> Despite a lack of overt CVD, patients had significantly higher IMT as compared to controls (0.9 [0.7–1.0] vs. 0.6 [0.4–0.7] mm; p > 0.001). Furthermore, in multivariate analysis IMT was independently associated with CKD stage, mean arterial pressure (MAP) and calcium-phosphate product, but not with Framingham risk factors. Following kidney transplantation, IMT decreased rapidly, reaching levels comparable to those in the controls within 90 days. In a time-dependent multivariate analysis, this decrease was predicted by changes in GFR, MAP, and uric acid levels. <i>Conclusion:</i> Our data does not exclude IMT as a predictor of mortality in CKD, but suggests that other etiologies than atherosclerosis may be more important in determining IMT levels in the population with CKD.