Objectives: Patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) have an increased risk of cardiovascular mortality and morbidity. Vascular calcification is a recognized risk factor for cardiovascular mortality in ESRD patients. And vascular calcification is associated with vascular access complications. We aimed to assess the association among the value of IMT, vascular access failure, such as thrombosis or stenosis, and pulse wave velocity(PWV) as an indicator of arterial stiffness in ESRD patients undergoing maintenance dialysis.  Methods: We enrolled 100 patients receiving HD over three months from a single outpatient HD clinic. We reviewed the patients' medical records, including age, sex, anthropometric values, HD duration, and blood pressure which were measured during hemodialysis. Amputee patients were excluded from this study. All patients underwent carotid doppler for evaluation of IMT. BaPWV is measured by recording pulse waves of both arms and both ankles from the pressure signal obtained by measuring 4-extremity blood pressure. Results: The median age was 66 years (interquartile range 58-76 years). Of 100 patients, 51 patients were male.(50.5%) The median duration of hemodialysis was 47.5 months (range 31.3-89.1 months). There were no significant differences between the high IMT group and the low IMT group in sex, hemodialysis vintage, end-stage renal disease etiology, and type of vascular access. However, age was significantly older in the high IMT group. IMT was significantly associated with PWV. (hazard ratio [HR] 2.109; 95% CI 1.037-4.291, P = 0.039). After adjusting for age, sex, and presence of diabetes, IMT was independently associated with PWV (HR 2.110, 95% CI 1.036-4.298, P = 0.040). The risk of recurrent vascular access failure was higher in the high IMT group (HR 1.615, 95% CI 1.460-5.669, P = 0.034). Conclusions: IMT was associated with PWV and recurrent access failure. Thus IMT may be suggested as a potential predictor of recurrent access failure.