Aim: Hemodialysis (HD) patients had higher cardiovascular mortality and it is related to atherosclerosis. Epicardial adipose tissue (EAT) thickness is a marker of atherosclerosis and independent predictor of coronary artery disease. The aim of our study was to evaluate the relationship between EAT and carotid intima-media thickness (CIMT) predictors of early atherosclerosis in HD patients. Methods: The study included 62 HD patients and 40 healthy controls. EAT thickness and CIMT were measured by echocardiography in all subjects. Results: Epicardial adipose tissue thickness and CIMT were higher (6.98 +/- 1.67 vs. 3.84 +/- 0.73 mm, P < 0.001, 0.94 +/- 0.17 vs. 0.63 +/- 0.11 mm, P < 0.001, respectively) in HD patients than in control subjects. EAT thickness were correlated with CIMT, HD duration, age, and calcium. In addition, HD duration, CIMT, and age were independent predictors of EAT thickness on HD patients in regression analysis. Conclusion: Epicardial adipose tissue thickness may be a useful indicator of early atherosclerosis in HD patients.