Chronic kidney disease ( CKD) is a globally prevalent chronic progressive disease that often coexists with atherosclerosis (AS); these conditions mutually reinforce each other, accelerating the occurrence of cardiovascular events and significantly impacting prognosis. While traditional risk factors can partly explain disease progression, CKD-specific factors such as uremic toxin accumulation, calcium-phosphorus metabolism disorders, the renin-angiotensin system, chronic inflammation, and oxidative stress also play important roles in AS progression. The RhoA/ ROCK pathway plays a crucial role in pathological processes such as vascular smooth muscle cell contraction,endothelial dysfunction, inflammatory responses, and oxidative stress, making it a key molecular mechanism in CKD and AS development. As a member of the small GTPase family, RhoA can activate downstream ROCK1 / ROCK2,leading to actin cytoskeletal remodeling and vascular tone regulation. In CKD, factors such as uremic toxin accumulation, elevated oxidative stress levels, and activation of the renin-angiotensin system can upregulate RhoA/ROCK signaling, further accelerating endothelial damage and AS plaque formation. Traditional Chinese medicine (TCM) and its active components have shown potential in interventional studies targeting this pathway. Various drugs, such as hirudin, hydroxy crocin, and rhodiola glycoside, can downregulate RhoA and ROCK expression or activity, improve endothelial function, and inhibit inflammation and oxidative stress, slowing the progression of CKD combined with AS. This study systematically evaluated the role of the RhoA/ ROCK pathway in CKD combined with AS and the progress of TCM interventions to help reveal the molecular disease mechanisms and provide new insights and strategies for clinical prevention and treatment.