BACKGROUND Chronic kidney disease (CKD) has been suggested to be associated with a high risk of cardiovascular diseases (CVD). The study aimed to evaluate the prognostic significance of nonesterified fatty acid (NEFA), also well known as free fatty acid, on predicting cardiovascular events in patients with CKD. METHODS A total of 957 hospitalized patients with CKD in a stable clinical condition were enrolled at baseline. Then, the serum NEFA levels were measured. These included patients were prospectively followed up for a median of 10.2 years (range=0.4-11.5 years). We assessed whether serum NEFA levels at baseline can predict cardiovascular event during the follow-up. RESULTS A total of 278 (29.1%) patients experienced cardiovascular events during follow-up. The Kaplan-Meier curve demonstrated that patients with higher serum NEFA levels (≥19.8 mg/dl) had a higher rate of cardiovascular events than patients with lower NEFA levels (<19.8 mg/dl). Multivariate Cox regression analysis suggested that elevated serum NEFA levels (HR=1.62; 95% CI 1.40-2.16, P<0.001) were independently associated with increased risk of cardiovascular events after correction for clinical confounding factors. CONCLUSIONS Elevated serum NEFA levels were associated with higher risk of cardiovascular events and may be a new parameter predicting cardiovascular events in patients with CKD, which may strengthen its potential effect in clinical practice.