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ObjectiveTo evaluate early retinal microvascular abnormalities in patients with chronic kidney disease (CKD) via optical coherence tomography angiography.MethodsA cross‐sectional study. Two hundred patients with CKD stage ≧3 were enrolled in the CKD group, and 50 age‐matched healthy subjects were enrolled in the control group. Main outcome measures were the differences in parafoveal vessel densities in the superficial vascular plexus (SVP) and deep vascular plexus (DVP) between the CKD and control groups.ResultsThe mean ages were 62.7 ± 10.1 in the CKD group and 61.9 ± 9.7 (P = 0.622) in the control group. The CKD group had reduced parafoveal vessel densities in SVP (46.7 ± 4.3 vs 49.7 ± 2.9, P < 0.001) and DVP (50.1 ± 4.1 vs 52. 6 ± 2.9, P < 0.001) when compared to those of the control group. In multiple linear regression models, age, diabetes, estimated glomerular filtration rate, and use of anti‐hypertensive drugs were factors associated with vessel density in SVP, whereas age, diabetes, and smoking were factors associated with vessel density in DVP.ConclusionPatients with CKD had reduced vessel densities in parafoveal SVP and DVP, as compared to that of control subjects. Microvasculature in the different retinal layers may be affected by different systemic factors.