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Summary Background and objectives Hyperuricemia is an independent risk factor for mortality, cardiovascular disease, and renal disease in general population. However, the relationship between hyperuricemia with clinical outcomes in CKD remains controversial. Design, setting, participants, & measurements The study investigated the association between uric acid with all-cause mortality, cardiovascular events, renal replacement therapy, and rapid renal progression (the slope of estimated GFR was less than −6 ml/min per 1.73 m2/y) in 3303 stages 3–5 CKD patients that were in the integrated CKD care system in one medical center and one regional hospital in southern Taiwan. Results In all subjects, the mean uric acid level was 7.9±2.0 mg/dl. During a median 2.8-year follow-up, there were 471 (14.3%) deaths, 545 (16.5%) cardiovascular events, 1080 (32.3%) participants commencing renal replacement therapy, and 841 (25.5%) participants with rapid renal progression. Hyperuricemia increased risks for all-cause mortality and cardiovascular events (the adjusted hazard ratios for quartile four versus quartile one of uric acid [95% confidence interval] were 1.85 [1.40–2.44] and 1.42 [1.08–1.86], respectively) but not risks for renal replacement therapy (0.96 [0.79–1.16]) and rapid renal progression (1.30 [0.98–1.73]). Conclusions In stages 3–5 CKD, hyperuricemia is a risk factor for all-cause mortality and cardiovascular events but not renal replacement therapy and rapid renal progression.