Ankle-brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in hemodialysis patients. However, it is seldom studied in southern Taiwan, an area with high prevalence of end-stage renal disease (ESRD). The aim of this study was to investigate the prevalence and associated risk factors for peripheral artery disease in the ESRD population in a hospital. All routine hemodialysis patients in one regional hospital were included except for six patients who refused ABI examinations and four patients with atrial fibrillation. Finally, 225 patients formed our study group. ABI was measured using an ABI-form device (Colin VP1000). The prevalence of ABI < 0.9 and > or = 1.3 was 15.6% and 5.8%, respectively. ABI < 0.9 was independently associated with advanced age (p = 0.027), increased pulse pressure (p = 0.005), increased hematocrit (p = 0.008) and decreased serum albumin level (p = 0.009). In addition, ABI > or = 1.3 was significantly associated with diabetes mellitus (p = 0.019). This study demonstrated the associated risk factors of peripheral artery disease in patients with hemodialysis in a hospital. ESRD patients of advanced age and with increased pulse pressure, increased hematocrit and decreased serum albumin level had a relatively high risk for ABI < 0.9 and patients with diabetes had a relatively high risk for ABI > or = 1.3.