Objective To clarify the association of BNP with atherosclerotic cardiovascular disease(CVD) and cardiac dysfunction in predialysis patients with chronic kidney disease(CKD). Methods Whole blood concentration of BNP was detected by fluorescence immunoassay in a cohort of 203 non-dialysis CKD patients and 16 hypertensive controls. The relationship of BNP with carotid artery atherosclerosis evaluated by B-ultrasound, echocardiographic parameter and history of cardiovascular disease in CKD patients was examined. Results BNP level was significantly higher in CKD patients than that in control subjects [54.40(15.10~173.00) ng/L vs 9.35(7.35~15.00) ng/L, P<0.01]. Spearman correlation showed that the BNP level was positively correlated with carotid intima-media thickness (IMT) and left ventricle mass index (LVMI). BNP concentration was significantly higher in patients with carotid plaques, left ventricular hypertrophy (LVH) and cardiovascular disease (CVD) history. Multiple regression analysis revealed that LVMI and CVD history were independent determinants of BNP. Conclusions BNP level is significantly correlated with atherosclerotic cardiovescular disease, LVH and cardiac dysfunction. BNP may be a sensitive biomarker for the evaluation of atherosclerosis and cardiac function in non-dialysis CKD patients.