Patients with end stage renal disease on regular hemodialysis (HD) have increased incidence of cardiovascular complications. The present study was conducted to determine the incidence of early vascular changes evidenced by increased carotid artery intima media thickness (IMT) and CT evidence of vascular calcification in 27 children on HD. The carotid artery intima media thickness was increased in 41% of cases. Six patients (22%) had vascular calcification by high resolution CT. Those with vascular calcification had significantly higher blood pressure. And tendency to higher IMT, higher EPO requirement, LV dilatation and impaired systolic function early evidence of vascular calcification is present in children on HD.