Background: Serum ADMA level was high in hemodialysis patients as compared to healthy control population. Increase in ADMA levels may play a role in atherosclerosis dependent morbidity and mortality. Objective: Assessment of the relationship between serum ADMA and atherosclerosis. Patients and Methods: Serum ADMA was measured using ADMA ELISA Kit; atherosclerosis was assessed by non- invasive methods including FMD and CIMT in 3 groups (50 ESRD patients undergoing hemodialysis, 25 CKD patients and 25 healthy control subjects). Results: CKD and ESRD patients on regular hemodialysis have significantly greater ADMA, CIMT and lesser FMD than do control subjects with normal renal function. Both groups of patients have higher cholesterol and triglycerides levels than do control subjects which could be related to serum ADMA.  Serum albumin was reduced in hemodialysis and CKD patients. It has an inverse correlation with serum ADMA. Conclusion: Patients of CKD and hemodialysis have earlier endothelial dysfunction than do control group and this explained why they have higher incidence of cardiovascular morbidity and mortality. Integration of ADMA into currently applied risk scores still needs to be validated.