【Abstract】Objective To understand the formation of carotid artery atherosclerosis (CAS) and its potential causes in maintenance hemodialysis (MHD) patients. Methods We recruited 55 MHD cases and measured their physical dimensions of bilateral carotid arteries by using high resolution ultrasonography. They were then assigned into plaque positive group or plaque negative group. Data were compared between the two groups. Logistic regression analysis was performed to disclose the potential factors leading to plaque generation.  Results Atherosclerotic plaque was found in 69.09% of the 55 MHD cases. The intima-media thickness (IMT) of the carotid arteries was significant larger in plaque positive group than in negative group (P=0.001). Other significant differences between the two groups included age (P=0.000), hemoglobin (Hb) level (P=0.01) and C reactive protein (CRP) level (P=0.002). Logistic regression analysis indicated that older age (β=1.102, P=0.014) and higher CRP level (β=0.138, P=0.026) were the two major contribution factors for atherosclerotic plaque formation.  Conclusions MHD patients have higher potential of CAS. Older age and higher CRP level are the two major risk factors for atherosclerotic plaque formation in carotid artery.