Elevated plasma lipoprotein (LPa) level in chronic renal failure patients is recognized as an independent risk factor for premature atherosclerotic coronary heart disease. In this cross-sectional study we aimed to study the effect of serum plasma LPa levels on early structural atherosclerotic vascular changes in chronic renal failure (CRF) predialysis and hemodialysis (HD) populations. We evaluated the carotid intima-media thickness and carotid-femoral artery for plaque occurrence (plaque score) by B-mode ultrasonography in 29 (17F, 12M) normal subjects (group one), 33 (19F, 14M) CRF predialysis patients (group 2) and 43 (19F, 24M) HD patients (group 3). The Mean LPa in group 1,2 and 3 were 42.0 +/- 20.0, 57.0 +/- 23.0 and 55.0 +/- 16.0 mg/dl, respectively (p=0.016). The Intimae- media thickness (IMT) of group 1, 2 and 3 was 0.84 +/- 0.20 1.30 +/- 0.40 and 1.10 +/- 0.30 mm, respectively (p< 0.001). Plaque scores between 1 and 2 were found in 6.8% of the subjects in group 1, 24.3% in group 2 and 25.6% in group 3 (p< 0.001). Furthermore, plaque scores of 3 and 4 were found in no subjects in group 1, 36.4% in group 2 and 23.3% in group 3. In conclusion; the present study showed positive relationship of LPa with IMT and arterial plaque in HD patients but not the CRF patients. However, accelerated atherosclerosis is frequently seen in these patients and larger clinical studies of this problem are needed.