Background: Worldwide, chronic kidney disease (CKD) is a major public health issue.  The Global Burden of Disease study stated that, worldwide mortality attributed to renal failure showed a tremendous rise with around 1.2 million deaths from renal failure in 2015. Atherosclerosis, especially peripheral arterial disease (PAD), is more common in people undergoing hemodialysis (HD). However, there are some correlations that appear to be unique to dialysis patients when it comes to risk factors for peripheral artery disease. Objective: To study the relation between PAD assessed by ankle brachial index (ABI) and serum level of 25(OH) vitamin D among maintenance HD patients from multiple dialysis centers in Kafr El-Sheikh Governorate, Egypt. Patients and Methods: From the dialysis centers in Kafr El-Sheikh Governorate, Egypt, a total of 90 ESRD patients on maintenance HD were recruited for this study and were divided into two groups, 45 with PAD assessed by ABI (value less than 0.9) and 45 without PAD assessed by ABI (value more than or equal 0.9). Study was done over six months starting from April 2019 till end of October 2019. Results: Serum 25(OH) vitamin D levels differed statistically significantly between the two groups (P< 0.001). Patients and control groups both showed a statistically significant positive connection between ABI and their serum vitamin D level (P< 0.001). Conclusion: PAD is linked to vitamin D insufficiency in people who are on maintenance hemodialysis.