Abstract Background: Rheumatoid arthritis (RA), an autoimmune systemic inflammatory condition, associated with an increased risk of cardiovascular disease (CVD). Recently, renal impairment was suggested to increase the risk of CVD in RA population. Aim of this study: To evaluate the association between impaired renal function and atherosclerosis in patients of rheumatoid arthritis . Patients and Methods: A cross sectional study on 72 RA patients carried out at Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University. The disease activity was evaluated by the Modified Disease Activity Score (DAS28). Clinical and laboratory assessment was performed with evaluation of carotid intima-media thickness (cIMT) and the presence of atherosclerotic plaques by Carotid ultrasonography, glomerular filtration rate (GFR) was estimated with Modification of diet in renal diseases ( MDRD ) formula to define chronic kidney disease (CKD). C-reactive protein (CRP) , rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and serum amyloid A ( SAA) were used as inflammation markers. Results: In this study we found that carotid intima-media thickness was abnormal in 33 (46%) of the patients. Age, waist circumference (WC) and disease duration found to be significantly higher in patients with abnormal cIMT. Besides CRP, RF, ESR, SAA and the modified (DAS28) were significantly higher with abnormal cIMT , while eGFR was significantly decreased in patients with abnormal cIMT. In the present study, there was highly negative significant correlation between cIMT and eGFR. Conclusion: Impaired renal function and long standing inflammation were associated with higher risk of atherosclerosis in RA population