Background: Patients with chronic kidney disease (CKD) or end stage renal disease (ESRD) are at increased risk of atherosclerosis and cardiovascular event. Paraoxonase 1 has atheroprotective effects through its role in lipid peroxidation. Objectives:  This study aimed to check serum paraoxonase 1 level and gene polymorphism (PON 1- Q192R) as an atherosclerotic marker in CKD patients in Menoufia University Hospitals, Egypt. Patients and methods: This case-control study included 65 patients with CKD attending Menoufia University Hospitals. Patients were classified into 2 groups: 30 patients on conservative therapy (Group II) and 35 ESRD patients on regular hemodialysis (HD) more than 6 months (Group III). Thirty healthy age- and gender-matched individuals were evaluated as control group (group I). Complete blood count, lipid profile, blood urea, serum creatinine, C-reactive protein, serum homocysteine and PON1 lactonase activity (human serum paraoxonase 1) were measured using commercially available enzyme-linked immunosorbent assay kits and genetic study (PON 1-Q192R) was determined by Real time polymerase chain reaction (PCR). Carotid intima media thickness (CIMT) was measured through ultrasonographic examination of carotid arteries. Results: CIMT was significantly higher in CKD patients than in control group. Serum PON 1 was significantly lower in ESRD patients on HD than in CKD patients predialysis, which in turn was significantly lower than in healthy control subject. There was statistical significant negative correlation between CIMT and PON 1 level. There was statistically significant difference between patients and control as regards paraoxonase gene polymorphism. Genotype QQ and Q allele were common in CKD & ESRD patients than in control.    Conclusion: Serum paraoxonase 1 level may be a potential biomarker of atherosclerosis in CKD patients.