Objective: Lateral lumbar radiography of the abdominal aorta was used to determine the overall AACS, which is related to the severity of calcific deposits at lumbar vertebral segments L1-L4. A total of 895 dialysis CKD patients from 19 multi-center were enrolled and 39 patients are excluded due to missing data. Patients were categorized by AACS (Low AACS group, AACS = 0, n = 269; Medium AACS group, AACS 1–4, n = 218; and High AACS group, AACS> 4, n = 369). We investigated prognostic value of AACS in dialysis CKD patients Methods: AACS was associated with age (OR = 1.18, P = 0.042), dialysis duration (OR = 1.23, P = 0.008), CVD (OR = 1.98, P = 0.02) and diabetes (OR = 2.25, P = 0.01). There were 204 MACCEs and significantly higher cumulative incidences of MACCE were observed in advanced AACS group. AACS was an independent predictor of MACCE (HR = 3.21, 95% CI 1.53–6.62, P = 0.03) in this study.  Results: CKD patients on dialysis with high AACS have substantially greater risk of future cardiovascular events and poorer prognosis. AACS was associated with age, diabetes, dialysis duration, CVD and high calcium & phosphorus level. AACS could predict MACCE in this population. Thus, providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better. Conclusions: Objective: Abdominal aortic calcification score(AACS) is independently associated with cardiovascular events indialysis patients. It has been shown that AACS is a predictor of adverse outcomes in chronic kidney disease patients, however evidence regarding its prognostic value are still insufficient and limited. We aimed to analyze prognostic value of AACS in dialysis CKD patients and examine the predictive role of AACS for major adverse cardiac and cerebrovascular events (MACCE). Methods: Lateral lumbar radiography of the abdominal aorta was used to determine the overall AACS, which is related to the severity of calcific deposits at lumbar vertebral segments L1-L4. A total of 895 dialysis CKD patients from 19 multi-center were enrolled and 39 patients are excluded due to missing data. Patients were categorized by AACS (Low AACS group, AACS = 0, n = 269; Medium AACS group, AACS 1–4, n = 218; and High AACS group, AACS> 4, n = 369). We investigated prognostic value of AACS in dialysis CKD patients Results: AACS was associated with age (OR = 1.18, P = 0.042), dialysis duration (OR = 1.23, P = 0.008), CVD (OR = 1.98, P = 0.02) and diabetes (OR = 2.25, P = 0.01). There were 204 MACCEs and significantly higher cumulative incidences of MACCE were observed in advanced AACS group. AACS was an independent predictor of MACCE (HR = 3.21, 95% CI 1.53–6.62, P = 0.03) in this study.  Conclusions: CKD patients on dialysis with high AACS have substantially greater risk of future cardiovascular events and poorer prognosis. AACS was associated with age, diabetes, dialysis duration, CVD and high calcium & phosphorus level. AACS could predict MACCE in this population. Thus, providing information on AAC may help clinicians understand and manage patients' cardiovascular risk better.