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This study aimed to assess the association between chronic kidney disease (CKD) and the risk of pulmonary tuberculosis (TB) before initiating renal replacement therapy (RRT) in Taiwan. Total 16,052 subjects newly diagnosed with CKD between 2000 and 2012 were included in the CKD group, and 31,949 randomly selected subjects who did not have CKD formed the non-CKD group. Subjects with a history of pulmonary TB or RRT, including dialysis and renal transplantation, before the index date were excluded. We determined the incidence of pulmonary TB at the end of 2013. A multivariable Cox proportional hazards regression model was used to assess the hazard ratio (HR) and 95% confidence interval (CI) for the risk of developing pulmonary TB associated with CKD. The overall incidence of pulmonary TB was 1.47-fold greater in the CKD group compared to that in the non-CKD group (4.94 vs 3.35 per 1000 person-years, 95% CI 1.39, 1.56). Multivariable Cox proportional hazards regression analysis showed that the adjusted HR of pulmonary TB was 1.45-fold higher in the CKD group (95% CI 1.27, 1.64) than in the non-CKD group. Male sex (adjusted HR 2.04), age (increase per one year, adjusted HR 1.05), chronic obstructive pulmonary disease (adjusted HR 1.54), and diabetes mellitus (adjusted HR 1.34) were also associated with pulmonary TB. CKD is associated with an increased risk of developing pulmonary TB before the initiation of RRT.