Background Chronic kidney disease (CKD) is very common now and is associated with high overall and cardiovascular mortality. Numerous studies have reported that abdominal obesity is a risk factor for cardiovascular mortality. We investigated the link between sagittal abdominal diameter (SAD) and Framingham risk score in non-dialysis CKD patients. Methods In a cross-sectional study, we enrolled 307 prevalent non-dialysis CKD patients (175 males, aged 50.7 +/- 17.04 years). SAD and Framingham risk score were measured. Results Framingham cardiovascular disease risk score was independently predicted by SAD (P < 0.01), GFR (P < 0.01) and diabetic history (P < 0.05). Adjusted R-2 of the model was 0.178. SAD could be independently predicted by BMI (P < 0.01), diabetic history (P < 0.01), GFR (P < 0.01) and age (P < 0.01). Adjusted R-2 of the model was 0.409. Using receiver operating characteristic (ROC) curve, a cutoff SAD value of 16.55 cm was determined with sensitivity of 63.7%, specificity of 58.3%. Conclusion Elevated SAD is significantly associated with increased Framingham risk score in non-dialysis CKD patients. SAD can be predicted by patients' BMI, diabetic history, renal function and age. Further investigation is needed to explore the potential benefits of central obesity lowering therapy in this patient group.