ABSTRACT Aim: We aimed to investigate the factors affecting the development of atherosclerosis and the role of calcification inhibitors fetuin-A, matrix-Gla protein (MGP), osteoprotegerin (OPG) in atherosclerosis progress. Material and methods: The study was planned to investigate the relationship of serum OPG, MGP and fetuin-A levels with the development of atherosclerosis in the stage 2–3–4–5 chronic kidney disease (CKD) patients who did not require dialysis treatment. Results: 32 (17 female, 15 male) healthy individuals and 92 (49 females, 43 males) CKD patients were included. The mean carotid intima-media thickness (CIMT), C-reactive protein (CRP), fetuinA, OPG and MGP of the two groups were compared statistically. In CKD patients, age, body mass index (BMI), CRP, triglyceride, urea, systolic blood pressure (SBP), fasting blood sugar have a positive linear relationship, fetuin-A, OPG, GFR have a negative linear relationship with CIMT. The mean CIMT, right CIMT, left CIMT, blood urea, CRP, urinary albumin excretion creatinine and age show a negative linear relationship with fetuin-A. Conclusion: Fetuin-A levels begin to decline from the early stages of CKD and are significantly lower in patients with atherosclerosis as expressed with CIMT. This suggests that fetuin-A may be used as an early marker in CKD for increased cardiovascular risk. Early recognition of these risk factors is important and large-scale studies on vascular calcification inhibitors are needed. Abbreviations: CKD: chronic kidney disease; ESRD: end-stage renal disease; BMPs: bone morphogenetic proteins; MGP: matrix-gla protein; OP G: osteoprotegerin; HD: hemodialysis; DM: diabetes mellitus; GFR: glomerular filtration rate; BMI: body mass index; FBG: fasting blood glucose; HDL: high density lipoprotein; LDL: low density lipoprotein; T G: triglyceride; Na: sodium; K: potassium; P O: phosphate; iP T H: intact parathormone; UAE: urinary albumin excretion; UP E: urinary protein excretion; CIMT: carotid intima-media thickness; ROC: receiver operating characteristics; HC: healthy control; NS: not significant; SBP: systolic blood pressure; DBP: diastolic blood pressure; T C: total cholesterol; CRP: C-reactive protein