Objective To investigate the relationship between carotid atherosclerosis(AS) and dialysis adequacy in hemodialysis(HD) patients.Methods Seventy-five HD patients were enrolled in this study. Clinical indexes and serum C－reactive protein (CRP) were measured, and intima-media thickness(IMT) of extracranial carotid artery and presence of atherosclerotic plaques were examined by high-resolution B-mode ultrasonography. Two groups were divided according to normalized protein catabolic rate(nPCR). Results The blood urea nitrogen(BUN), serum creatinine（Scr）, total protein(TP), serum albumin(Alb), Kt/V in nPCR≥1.0 group with HD were significantly higher than nPCR＜1.0 group, and CRP, mean IMT, incidence of plaque occurrence and increased IMT were significantly increased in nPCR＜1.0 group. There was relationship between nPCR and CRP, Alb, BUN, Scr and mean IMT in HD patients. Conclusions nPCR is a helpful index to estimate the dialyisi adequacy and malnutrition in HD patients. There was relationship between nPCR and micro-inflammation, carotid AS and malnutrition. The microin-flammation, carotid AS and malnutri-tion influenced each other, Microin-flammation is the center link among those factors.