Objective Ankle-brachial Index (ABI) is noninvasive and simple to measure. An ABI less than 0.90 is 95% sensitive and 99% specific for peripheral arterial occlusive disease (PAOD) in general population. The purpose of this study is to evaluate the sensitivity and specificity of ABI for lower-extremity PAOD in patients with end stage renal disease(ESRD). Methods Seventy-three ESRD patients including 31 non-dialysis patients and 42 on hemodialysis were enrolled in this study. With ultrasound machine HDI5000 and 5 to 10MHz scaners, all their double iliac arteries, femoral arteries, posterior tibial arteries, fibular arteries and dorsalis pedis arteries were measured to determine whether a lower-extremity PAOD existed or not. The items included tunica intima, lumen diameter, peak systolic velocity, end diastolic velocity, pulsitive index and resistent index. In addition, ABIs were calculated on the basis of the systolic pressures at posterior tibial arteries, dorsalis pedis arteries and brachial arteries(non-fistula). Based on the results with doppler ultrasonography, the sensitivity and specificity of ABI for lower-extremity PAOD were analysed. Results The doppler ultrasound examination showed lower-extremity PAODs were found in 50.68%(37/73) ESRD patients, including 51.61%(16/31) non-dialysis patients and 50%(21/42) on hemodialysis. If An ABI0.90 or less was defined as PAOD, the sensitivity and specificity of ABI for lower-extremity PAOD in ESRD patients were 81.08% and 97.22% respectively, and Kappa value was 0.78. Conclusions Lower-extremity PAOD is common in ESRD patients and most of which are asymptomatic. ABI is a reliable screening tool for asymptomatic lower-extremity PAOD in this population.