BACKGROUND: This study aims to test the lipoprotein-associated phospholipase A2 (Lp-PLA2) mass and activity in patients with chronic kidney disease (CKD) and to analyze their connection of Lp-PLA2 with the development of disease and with the occurrence of atherosclerosis in this population. MATERIALS AND METHODS: In total, 59 patients older than 18 years and with a diagnosis of CKD were recruited. Kidney function was evaluated by serum creatinine, serum urea and estimated glomerular filtration rate according to Chronic Kidney Disease Epidemiology Collaboration formula and clinical data were collected. A total of 24 healthy volunteers served as healthy controls. Lp-PLA2 mass is measured by enzyme-linked immunosorbent assay. Lp-PLA2 activity is determined by an enzymatic platelet-activating factor acetylhydrolase assay. RESULTS: Serum mass and activity of Lp-PLA2 were higher in patients with CKD compared with healthy controls (P < 0.001 and P = 0.031). There was a positive linear relationship betweenLp-PLA2 mass and activity in the patients with CKD (r = 0.586, P < 0.001). The similar result was observed in the healthy controls (r = 0.585, P = 0.003). However, the ratio of Lp-PLA2 mass to activity in the patients with CKD was significantly higher than those of healthy controls (P < 0.001). Lp-PLA2 mass and activity were correlated with low-density lipoprotein (r = 0.366 and r = 0.303, P = 0.004 and P = 0.02). CONCLUSIONS: Lp-PLA2 mass and activity increase in patients with CKD. Elevated mass and activity of Lp-PLA2 related to inflammation and atherosclerosis may take part in the development of kidney injury and atherosclerosis in patients with CKD.