Objective To study the relationship between carotid atherosclerosis and serum adiponectin(ADPN) level in hemodialysis patients. Methods The right carotid intima-media thickness(IMT) were studied by B-model ultrasound and plasma ADPN were detected in 40 maintenance hemodialysis patients（HD group） as well as in 20 healthy individuals（control group）. Results The serum ADPN level was significantly higher in hemodialysis group than in control group; But the ADPN level of carotid atherosclerosis group was lower than in normal carotid group. The relative analysis showed that there severity of carotid atherosclerosis was negatively correlated with serum ADPN level. Conclusion The probability of carotid atherosclerosis in hemodialysis patients is thicker higher than healthy individuals. We concluded carotid atherosclerosis is related to correlated with serum ADPN. ADPN may participate in the development of carotid atherosclerosis. To measure serum ADPN will give us provide a new method to estimate the degree of carotid pathological changes in hemodialysis patients.