Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor and is associated with the incidence of atherosclerosis (AS). ADMA is increased in patients with chronic kidney disease (CKD), which is a predictor of early endothelial dysfunction in CKD and a serologic marker of AS. ADMA can directly lead to or indirectly promote AS, and the concentration of ADMA in vivo is relatively stable, not being easily influenced by other factors. So the prediction value of ADMA for AS and its adverse events in CKD patients is extremely high. ADMA can not only be used for early detection of AS but also be used for reflecting the effectiveness of early intervention and patients' response to treatment by monitoring its dynamic changes, helping in understanding the progress and predicting the prognosis of the disease. This paper reviews the causes of the increase of ADMA and its role in promoting the development of AS in CKD patients.