<p>Chronic kidney disease (CKD) is a progressive illness associated with multiple systemic complications, including hearing loss, which can harm communication and overall quality of life. Identifying the burden and patterns of hearing loss in patients with CKD is crucial for early detection and intervention. This study aimed to determine the prevalence and characteristics of hearing loss among patients with CKD and explore its associations with comorbid conditions and treatment factors. This cross-sectional study included 138 patients with CKD at a tertiary care hospital. Pure tone audiometry was used to measure the hearing thresholds, whereas impedance audiometry excluded conductive hearing loss. Data were collected on diabetes, hypertension, ototoxic drug exposure, CKD staging, and dialysis status. Statistical analysis included chi-square testing with significance set at <i>p</i> &lt; 0.05. Hearing loss was observed in 89 patients (64.5%), of whom 72 (80.9%) had sensorineural hearing loss. High-frequency involvement was reported in all affected patients, with 70.8% showing low-frequency involvement and 87.6% demonstrating hearing loss at all frequencies. Hearing loss was significantly associated with diabetes (<i>p</i> = 0.009), hypertension (<i>p</i> &lt; 0.0001), and ototoxic medication exposure (<i>p</i> = 0.007). No significant association was found between dialysis and hearing loss. Most patients were in advanced CKD stages, with 65.2% of them receiving dialysis. There is a high prevalence of sensorineural hearing loss in patients with CKD, which is closely linked to diabetes, hypertension, and ototoxic drug exposure. Early hearing screening and integrated nephrology-audiology services are important for preventing further deterioration.</p>