The heart-kidney crosstalk is recognized as the cardiorenal syndrome. We examined the association of cardiac function and structure with the risk of kidney failure with replacement therapy (KFRT) in a chronic kidney disease (CKD) population. Prospective observational cohort study. 3,027 participants from the Chronic Renal Insufficiency Cohort Study. Five pre-selected variables that assess different aspects of cardiac structure and function: left ventricular mass index (LVMI), LV volume, left atrial (LA) area, peak tricuspid regurgitation (TR) velocity, and left ventricular ejection fraction (EF) as assessed by echocardiography. Incident KFRT (primary outcome), and annual eGFR slope (secondary outcome). Multivariable Cox models and mixed-effects models. Mean age was 59 (SD 11) years, 54% were men, and mean eGFR was 43 (17) ml/min/1.73m2. Between 2003 and 2018 (median follow-up, 9.9 years), 883 participants developed KFRT. Higher LVMI, LV volume, LA area, peak TR velocity, and lower EF were each statistically significantly associated with an increased risk of KFRT, with corresponding HRs for the highest vs. lowest quartiles (lowest vs. highest for EF) of 1.70 (95%CI, 1.27 to 2.26), 1.50 (1.19 to 1.90), 1.43 (1.11 to 1.84), 1.45 (1.06 to 1.96), and 1.26 (1.03 to 1.56), respectively. For secondary outcome, participants in the highest vs. lowest quartiles (lowest vs. highest for EF) had a statistically significantly faster eGFR decline, except for LA area (ΔeGFR slope per year, -0.57 [95%CI, -0.68 to -0.46] mL/min/1.73m2 for LVMI, -0.25 [-0.35 to -0.15] mL/min/1.73m2 for LV volume, -0.01 [-0.12 to -0.01] mL/min/1.73m2 for LA area, -0.42 [-0.56 to -0.28] mL/min/1.73m2 for peak TR velocity, and -0.11 [-0.20 to -0.01] mL/min/1.73m2 for EF, respectively). The possibility of residual confounding. Multiple aspects of cardiac structure and function were statistically significantly associated with the risk of KFRT. These findings suggest that cardiac abnormalities and incidence of KFRT are potentially on the same causal pathway related to the interaction between hypertension, heart failure, and coronary artery diseases.