Chronic kidney disease (CKD) is associated with end stage renal disease, as well as cardiovascular morbidity and mortality. The prevalence of CKD has rapidly increased with obesity epidemic. Cross sectional and cohort studies showed that an increased body mass index was significantly associated with the development of CKD and deterioration of renal function. Complex mechanistic linkage between obesity and CKD could be explained through renal oppression by fat tissue, increased angiotensinogen production, activation of sympathetic activity, insulin resistance, and increased inflammatory cytokines. Serum levels of adipokine (leptin, adiponectin) are markedly elevated in chronic kidney disease. High levels of serum adipokine attributed to cardiovascular disease and early death in CKD through their effects on insulin signaling, endothelial dysfunction, and increase of inflammatory cytokine. Patients with end-stage renal disease (ESDR) under hemodialysis showed that an increased body mass index (BMI) was associated with better survival. The possible causes and mechanisms of reverse epidemiology was not fully understood, but concurrent chronic disease, wasting, inflammation, insulin resistance and vascular injuries might be related. Obesity management and prevention is important, because it is a modifiable risk factor that is closely related with CKD as well as CKD associated cardiovascular risk factors.