We evaluated the prevalence, predictors, and outcome of peripheral arterial disease (PAD) among hemodialysis (HD) patients (n = 252) in a prospective study (3-year follow-up) conducted in Qatar. Those with PAD (n = 97; 38.5%) were older and more likely to be males and to have diabetes mellitus, prior coronary artery disease (CAD), or cerebrovascular disease. Diabetic retinopathy was an independent predictor of PAD (adjusted odds ratio: 2.7; P = .004). Women had a higher mortality. Three-year all-cause mortality was high in the PAD group (adjusted hazard ratios [HRs] 2.92; 95% confidence interval [CI] 1.55-5.51). Other predictors of mortality were age (HR 1.06; 95% CI 1.04-1.10), number of vascular access (HR 2.3; 95% CI 1.04-5.01), and prior CAD (HR 1.8; 95% CI 1.05-3.49). Prevalence of PAD was high among HD patients. Early detection of PAD as well as diabetic retinopathy is of value in identifying an even higher risk population among HD patients.