Objective <p>This study aimed to investigate the value of shear wave elastography (SWE) and an ultrasonic multi-parameter score in identifying chronic kidney disease (CKD) stage ≥ III (moderate-to-severe CKD) in patients with known CKD.</p> Methods <p>A single-centre cross-sectional study was conducted, enrolling 152 patients with CKD (staged I–V according to estimated glomerular filtration rate). Conventional ultrasound parameters (renal length, parenchymal thickness, echogenicity) and SWE measurements (Young’s modulus [YM] in kPa) of the renal cortex and medulla were obtained. The ultrasonic multi-parameter score was calculated using a standardised rubric. Receiver operating characteristic curve analysis was performed to evaluate the diagnostic performance of SWE cortical YM and the multi-parameter score for identifying CKD stage ≥ III.</p> Results <p>The study included 23 patients with stage I CKD, 45 with stage II, 44 with stage III, 15 with stage IV and 25 with stage V. Shear wave elastography cortical YM (area under the curve [AUC]: 0.894) and the multi-parameter score (AUC: 0.870) showed promising discrimination for stage ≥ III CKD. Cortical YM demonstrated a specificity of 0.912 and a sensitivity of 0.671.</p> Conclusion <p>Shear wave elastography cortical YM has high specificity, supporting its potential role in the rule-in of moderate-to-severe CKD. The ultrasonic multi-parameter score also shows clinical value for severity stratification. However, the relatively low sensitivity limits its utility for rule-out purposes.</p> Clinical trial number <p>Not applicable.</p>