Background: Atherosclerotic disease (ASO) is considered a serious problem in dialysis patients. We tried to clarify the characteristics of ASO and to evaluate its impact on survival. Methods: Between January 1990 and December 1999, 525 patients with end-stage renal disease were admitted to our hospital. Among these patients, 71 (59 male and 12 female) had ASO. Blood pressure and blood samples were measured before and after hemodialysis, and were compared with the hemodialysis patients without any cardiovascular diseases. Mortality findings were collected until April 30, 2000. Results: Patients with ASO contained a larger percentage of males, hypertension, hyperlipidemia, diabetes mellitus, nephrosclerosis and smoking status. Their serum calcium, serum phosphate, triglyceride and C-reactive protein levels were also higher. During the follow-up period (2.8 ± 0.2 years), the mortality rate of the patients with ASO was higher than the hemodialysis patients without any cardiovascular diseases. Among the patients with ASO, the significant covariates concerning the cardiovascular mortality rate were age, hyperlipidemia and smoking status according to the Cox Proportional Hazards regression analysis. Conclusions: Hemodialysis patients with ASO had many traditional risk factors and uremic risk factors. Their survival rate was poorer and dependent on these risk factors.