Background: Chronic kidney disease (CKD) is a global health burden with high economic costs and an independent risk factor for cardiovascular disease in healthy systems (CVD). Nevertheless, in the development of atherosclerosis, chronic inflammation and endothelial dysfunction are critical events; both are present in CKD and HD patients. Thrombomodulin (TM) is a transmembrane glycoprotein originally located on the vascular endothelium that is expressed on the cell surface. In natural human anticoagulation systems, TM on vascular endothelial cells is a significant molecule. In atherosclerosis, TM has specific impacts on cell proliferation, adhesion and inflammation, all of which are essential measures. Aims: The aim of the present study is to detect the relationship between thrombomodulin and atherosclerosis in chronic kidney disease patients. Materials and Methods Thrombomodulin (TM) was assessed in blood specimens of 38 patients with CKD (19 patients with CKD who did not begin HD (Group 2) and 19 patients with CKD who were on regular HD for more than 6 months (Group 1) and compared to 19 control subjects (Group 3) (Control Group). Results: The mean value of Thrombomodulin (TM) in the control group (430.2±102), the mean value in the CKD predialysis group (521.1±198) and The mean value in the CKD on HD group (729.4±513),thus The mean values Thrombomodulin (TM cells in CKD on HD group was significantly higher than that of the control group (P=0.00), and The mean value of Thrombomodulin (TM) was higher in the CKD group for HD than in the CKD group for predialysis, and there was a substantial difference among the CKD group for predialysis and the CKD group for HD (P=0.00), but there was no substantial difference among the CKD group for predialysis and the control group (p=0.4). There is a high significant direct correlation between Thrombomodulin (TM) and CIM in the studied groups r=(0.618)and p(<0.01). .Conclusions: In CKD patients, not only is Thrombomodulin (TM) strongly extended, but this expansion is correlated with preclinical atherosclerosis. In the CKD (predialysis and regular HD) groups, there was an independent association between thrombomodulin (TM, age, hsCRP) and IMT.