Background <p>Elevated serum uric acid levels are commonly observed in chronic kidney disease (CKD) and are associated with cardiovascular disease (CVD). Research on the role of serum uric acid in pediatric CKD is limited. This study aims to investigate factors influencing serum uric acid levels and their association with CVD risk factors in children with CKD.</p> Methods <p>We used baseline data from the KoreaN cohort study for Outcome in patients with Pediatric Chronic Kidney Disease. Overall, 338 children with CKD were included.</p> Results <p>The median age of participants was 9.8&#xa0;years, and their mean estimated glomerular filtration rate (eGFR) was 63.5&#xa0;mL/min/1.73 m². The median serum uric acid level was 5.8&#xa0;mg/dL. Multivariable regression analysis indicated that male sex, older age, and low eGFR were associated with higher serum uric acid levels. In children with CKD stage III or higher, glomerulopathy as the etiology of CKD was also associated with elevated serum uric acid levels. Serum uric acid levels showed a U-shaped relationship with the prevalence of hypertension and left ventricular hypertrophy, with the lowest prevalence occurring at levels between 5.5 and 7.5&#xa0;mg/dL<b>,</b> even after adjustment for covariates, with the lowest odds ratio in this range.</p> Conclusions <p>In pediatric CKD, higher serum uric acid levels were associated with male sex, older age, and lower eGFR, suggesting that these factors should be considered in clinical management. Additionally, the U-shaped relationship between serum uric acid levels and cardiovascular risk of hypertension and left ventricular hypertrophy underscores the importance of maintaining serum uric acid within an optimal range.</p> Graphical abstract <p></p>