End-stage kidney disease registry data have reported increased mortality in patients with as compared to those without diabetes. Here we examine whether diabetes is independently associated with an increased risk of major cardiovascular events and death in patients with advanced chronic kidney disease (CKD). Methods: Data from 315 participants with CKD in the Atherosclerosis and Folic Acid Supplementation Trial (ASFAST) were assessed. Primary endpoints were fatal or non-fatal cardiovascular events including myocardial infarction, stroke, unstable angina, coronary revascularization and peripheral vascular events assessed both jointly and separately using Cox-proportional hazard models. Results: Twenty-three percent reported diabetes. Median follow-up was 3.6 years. In those with diabetes, an increased risk for major cardiovascular events was observed, crude HR 2.87 (95 confidence interval [CI] 2.11-3.90). After adjustment for age, gender, smoking, systolic BP, BMI, past ischaemic heart disease and use of preventive therapies, diabetes was associated with an HR of 1.83 (1.28-2.61) for major cardiovascular events. The risk for peripheral vascular events was also increased, adjusted HR 6.31 (2.61-15.25). For all-cause death, major coronary and stroke events the risk in those with diabetes was not significantly increased (all-cause death, adjusted HR 1.31 [95 CI 0.80-2.14]; major coronary events, adjusted HR 1.26 [95 CI 0.64-2.49]; and major stroke events, adjusted HR 1.28 [95 CI 0.55-2.99]). Conclusions: Diabetes significantly increases the risk of major cardiovascular events, especially peripheral vascular events in patients with advanced chronic kidney disease. Trials of multi-factorial management of cardiovascular risk factors are required to determine if outcomes for this population may be improved.