Few studies have examined the relationship between retinal microvascular abnormalities and chronic kidney disease (CKD). This study aims to examine the association between retinal vessel diameters and CKD in the rural China in order to provide the scientific basis for the early detection and diagnosis for CKD.Participants and data were extracted from the Handan Eye Study, a population-based cross-sectional study performed from 2006 to 2007. The central retinal arteriolar equivalent (CRAE) and central retinal venular equivalent (CRVE) were summarized by the average arteriolar and venular caliber of each eye. The estimated glomerular filtration rate (eGFR) and a urinary albumin to creatinine ratio (ACR) were recorded. Multivariate logistic regression models were used to determine any associations between CRAE, CRVE, arteriole-to-venule ratio (AVR), retinopathy, and CKD in the recruited participants.CKD was found in was 17.3% (892/5158) of this population with a 0.9% (48/5545) rate of reduced renal function and 16.7% (922/5538) rate of albuminuria. Retinopathy was present in 9.6% (571/5925) of participants. Compared to the 4th quartile of AVR, the first group was found to have a higher risk of albuminuria (odds ratio [OR]=1.261, 95% confidence interval [95%CI]: 1.015-1.567, P=0.037) and CKD (OR=1.240, 95%CI: 1.000-1.537, P=0.049) after adjustment for potential confounding variables. Retinopathy was associated with the occurrence of albuminuria (OR=1.340, 95%CI: 1.067-1.685, P=0.012) and CKD (OR=1.341, 95%CI: 1.071-1.681, P=0.010). In participants with diabetes, the ORs for the 1st and 4th quartiles of CRAE and CRVE were 2.292 (95%CI: 1.076-4.881, P=0.032) and 2.113 (95%CI: 1.006-4.438, P=0.048), respectively. Among the participants with hypertension, retinopathy was also observed to be associated with CKD (OR=1.306, 95%CI: 1.003-1.699, P=0.047).The parameters of retinal vessel diameter may be a useful index evaluating the occurrence and development of CKD.