Background: Early cardiovascular disease (CVD) management and prediction have become mandatory in children with chronic kidney disease (CKD). Association between neutrophil gelatinase-associated lipocalin (NGAL) and CVD events in pediatric CKD patients remains unclear. Thus, we aimed to evaluate this relationship and to clarify the association between NGAL serum levels and some CVD related parameters. Subjects and methods: A total of 70 children patients with CKD (30 with and 40 without CVD). The patient's data were retrospectively recorded from the medical files of each patient. NGAL serum levels were measured by ELISA commercial kits. Association between different parameters was assessed by the Pearson correlation coefficient. Results: NGAL serum levels were significantly (P<0.0001) higher in patients with CVD (2450 (1335-2880) pg/mL) than patients without CVD (371 (285-1363) pg/mL) and healthy controls (295 (166-357) pg/mL). At 1300 pg/mL, NGAL has a good CVD predictive function with a high area under curve (AUC=0.871). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 80, 80, 63.2, 90.3, and 80%, respectively. CVD risk increase with elevated NGAL serum levels (>1300 pg/mL) (OR=2.57, 95 CI (1.62-4.09), P<0.0001). Carotid intima thickness was associated with elevated NGAL levels. Both NGAL and carotid intima thickness were significantly correlated with dialysis duration, uric acid, and lipid profile. Conclusion: NGAL was associated with CVD events in children with CKD with good predictive value supporting NGAL putative role in CVD pathophysiology. But NGAL in CVD is still in the early stages and future studied needed to evaluate its association with CVD severity.