Background <p>Patients with chronic kidney disease (CKD) exhibit elevated remnant cholesterol (RC) and high-sensitivity C-reactive protein (hs-CRP), and both of them contribute to the residual cardiovascular risk. However, the independent effects of RC and its joint effects with hs-CRP remain unknown. This study aimed to explore the associations of RC and its joint categories with hs-CRP with coronary heart disease (CHD), myocardial infarction (MI), and angina among patients with CKD.</p> Methods <p>This prospective study included 21,914 participants with CKD free of CHD from UK Biobank. RC was calculated as non-high-density lipoprotein cholesterol minus measured low-density lipoprotein cholesterol. Cox models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CHD. Fine and Gray’s model with age as the underlying timescale was used to evaluate the lifetime risks.</p> Results <p>Over a median follow-up of 11.99 years, 3403 CHD cases were documented. RC was positively associated with CHD, MI, and angina in a linear manner (<i>P</i> _nonlinearity &gt;0.05), with HRs (95% CIs) of 1.09 (1.06–1.13), 1.10 (1.05–1.17), and 1.13 (1.07–1.19) for per standard deviation increase. Compared with low RC/low hs-CRP, low RC/high hs-CRP and high RC/low hs-CRP had 29% (HR 1.29, 95% CI 1.19–1.39) and 44% (1.44, 1.25–1.67) increased risk of CHD, and high RC/high hs-CRP had the highest risk (1.56, 1.38–1.75). Consistent associations were also observed for MI and angina. Moreover, the cumulative CHD risk by age of 80 among high RC/high hs-CRP was much higher than that among low RC/low hs-CRP (35.17% vs. 25.27%).</p> Conclusions <p>Elevated RC was linearly and positively associated with increased risk of incident CHD. Combined high RC and hs-CRP conferred the highest relative and absolute risks. Our findings highlighted the importance of targeting RC and hs-CRP combined to reduce the cardiovascular risk among patients with CKD.</p>