ABSTRACT Background: Chronic kidney disease (CKD) is a major global health problem and a leading cause of morbidity and mortality worldwide. In low-resource settings, optimizing readily available diagnostic tools is essential for effective disease assessment and monitoring. Ultrasonography is widely used in chronic kidney disease (CKD) evaluation due to its noninvasive nature, affordability, and accessibility. Both morphologic and hemodynamic sonographic parameters may reflect structural renal damage and correlate with renal function. Objective: To evaluate grayscale sonographic characteristics and determine their correlation with estimated glomerular filtration rate (eGFR) among adult patients with chronic kidney disease undergoing abdominal ultrasound at Tibebe Ghion Comprehensive Specialized Hospital, Bahir Dar, Ethiopia. Material and Method:A hospital-based cross-sectional study was conducted among 90 adult patients with chronic kidney disease(CKD) between September 1, 2025, and January 15, 2026. Grayscale renal ultrasonography was performed to assess kidney length, renal parenchymal thickness, renal cortical thickness, and cortical echogenicity. Estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease (MDRD) equation. Correlations between sonographic parameters and eGFR were analyzed using Spearman’s rank correlation and multiple linear regression. Results:A statistically significant strong positive correlation was observed between eGFR and kidney length (rₛ = 0.634, 95% CI: 0.487–0.746, p < 0.001). Moderate positive correlations were noted between eGFR and renal parenchymal thickness (r = 0.48, p < 0.001) as well as renal cortical thickness (r = 0.35, p = 0.02). Renal cortical echogenicity demonstrated a strong negative correlation with eGFR (ρ = −0.60, p < 0.001). Multiple linear regression analysis revealed kidney length and renal parenchymal thickness as independent predictors of estimated glomerular filtration rate (eGFR). Conclusions: Renal ultrasonographic parameters, particularly kidney length and cortical echogenicity, showed significant correlations with estimated glomerular filtration rate in adults with chronic kidney disease. Kidney length demonstrated the strongest positive association with renal function, while increased cortical echogenicity was strongly associated with declining eGFR. These findings support the use of ultrasonography as a reliable, non-invasive, and accessible tool for assessing structural changes and estimating disease severity in CKD, especially in resource-limited settings.