BACKGROUND: Galectin-3 as a β-galactoside-binding lectin, which has served important functions in numerous biological activities including cell growth, apoptosis, pre-mRNA splicing, differentiation, transformation, angiogenesis, inflammation, fibrosis, and host defense, may be used in prediction of clinical outcomes in CKD patients. However, the given results remain debatable and inconclusive. Hence, we performed a comprehensive meta-analysis to clarify the predictive value of galectin-3 in patients with CKD, especially ESRD patients going on dialysis. METHODS: PubMed and Embase electronic databases were searched to identify eligible studies reporting the association between galectin-3 and adverse outcomes in CKD patients. We searched the literatures published October 2018 or earlier. We used both fix-effects and random-effects models to calculate the overall effect estimate. An I > 50% indicates at least moderate statistical heterogeneity. A sensitivity analysis and subgroup analysis were performed to find the origin of heterogeneity. RESULTS: We ultimately enrolled five studies with a total of 5226 patients in this meta-analysis. The result showed that high galectin-3 levels were associated with increased risk of all-cause mortality and cardiovascular (CV) events in CKD patients. For every 1% increased in galectin-3, the risk of all-cause mortality increased by 37.9% (HR 1.379, 95% CI 1.090-1.744). Much more, the risk of CV events in CKD patients was also significantly increased (HR 1.054, 95% CI 1.007-1.102) with no statistical heterogeneity among the studies (I = 0.0%, p = 0.623). However, there was no statistical difference between the risk of all-cause mortality and galectin-3 in HD patients (HR 1.171, 95% CI 0.963-1.425). CONCLUSIONS: Our meta-analysis suggests that high levels of galectin-3 may increase the risk of all-cause mortality and CV events in CKD patients, however, probably not a sensitive biomarker for outcomes in HD patients. Further studies were warranted to validate our findings.