AABPI, calculated as the ratio of systolic ankle/systolic arm blood pressure, has been recently found to be a strong predictor of cardiovascular and overall mortality in hemodialysis patients. The aim of our study was to confirm the role of this test in dialysis patients, a population with high prevalence of vascular diseases. Two hundred and twenty-six patients were studied, of which the AABPI could be measured in 217. There were 134 males (61%) and 83 females (39%) with a mean age of 61.3 +/- 17.4 years. The mean AABPI for the studied patients was 1.02 +/- 0.26; a past history of coronary artery (CAD), and/or cerebrovascular (CVD), and/or peripheral vascular disease (PVD) was present in 97 (45%) of these patients. This latter group had a mean AABPI less than controls with any vascular diseases (0.9 vs 1.1 p < 0.0001). For patients with or without CAD and PVD, the AABPI was respectively 0.84 +/- 0.3 vs 1.06 +/- 0.23 (p < 0.001) and 0.91 +/- 0.28 vs 1.08 +/- 0.22 (p < 0.001). In the group of patients with CAD, CAV, and PVD the positive and negative predictive value of AABPI was respectively of 66 and 74%. Diabetes was associated with a significantly lower AABPI (p < 0.02), gender did not influence AABPI. Significant positive correlation was found between AABPI and age (r2 = 0.46; p < 0.01). For patients with CAD, CVD and/or PVD no differences were found in serum lipid parameters (triglycerides, cholesterol, HDL-cholesterol, and lipoprotein a). Cumulative survival curves showed a lower mortality in patients with AABPI. 0.9 (Logrank test p < 0.001). We confirm that AABPI is a powerful non-invasive marker for the presence of systemic atherosclerotic disease in hemodialysis patients.