Background: Chronic kidney disease (CKD) is a well-established risk factor for cardiovascular disease (CVD), with increased mortality due to accelerated atherosclerosis. Carotid intima-media thickness (CIMT) is a reliable marker of subclinical atherosclerosis and cardiovascular risk. Objective: This study aimed to investigate the effect of CKD on CIMT and its correlation with CVD risk factors. Patients and methods: Over a six-month period from January to June 2022, 200 participants aged 30 to 60 years were enrolled in a case-control study at Ain Shams University Hospitals. The case group comprised 150 CKD patients with varying degrees of renal impairment (eGFR ranging from 17 to 88 mL/min), while the control group included 50 healthy subjects with eGFR > 90 mL/min. CIMT was measured using duplex ultrasonography, and both clinical characteristics and laboratory findings were analyzed. Results: CKD patients had significantly increased CIMT compared to controls (1.10 ± 0.16 mm vs. 0.49 ± 0.15 mm, P < 0.001). CIMT increased with CKD severity, being highest in patients with eGFR 15–29 mL/min (1.30 ± 0.08 mm). CIMT positively correlated with age (r = 0.377, P < 0.001), systolic blood pressure (SBP) (r = 0.311, P < 0.001), creatinine (r = 0.868, P < 0.001), and total cholesterol (TC) (r = 0.387, P < 0.001), while it negatively correlated with eGFR (r = -0.960, P < 0.001). Diabetic and hypertensive CKD patients had significantly higher CIMT than non-diabetic and normotensive counterparts (P = 0.001, P = 0.005, respectively). Conclusion: CIMT is significantly increased in CKD patients, correlating with declining renal function and traditional cardiovascular risk factors.