Aim To observe the change of high-density lipoprotein （HDL） cholesterol efflux capacity in patients with end-stage renal disease（ESRD）, and explore its relationship with the atherosclerosis risk understand effects of a single hemodialysis on HDL cholesterol efflux capacity. Methods Serum concentration of triglyceride（TG）, total cholesterol （TC）, high-density lipoprotein cholesterol （HDLC）, low-density lipoprotein cholesterol （LDLC）, apolipoprotein A1 （ApoA1）, ApoB, high sensitivity C-reactive protein （hs-CRP） and soluble vascular cell adhesion molecule-1 （sVCAM-1） in ESRD group and control group were detected, and the cholesterol efflux capacity of each group were tested by liquid scintillation counter. The above indexs were detected before and after dialysis in hemodialysis group. The intima-media thickness of carotid artery （CIMT） in each group was measured by ultrasound. Results The serum levels of TG, TC, ApoB, hs-CRP and sVCAM-1 in ESRD group was significantly higher than that of control group, and HDL cholesterol efflux capacity in ESRD group was significantly decreased than control group. CIMT in ESRD group was obviously higher than that of control group, and there was an obvious negative correlation between CIMT and cholesterol efflux capacity. After a hemodialysis, the cholesterol efflux rate of ESRD patients was a little higher than predialysis, but the difference was not statistically significant. And there were no statistical significance of TG, TC, HDLC, LDLC, ApoB and hs-CRP levels before and after hemodialysis. Compared with predialysis, the serum levels of ApoA1 and sVCAM-1 were significantly increased. Conclusion HDL mediated cholesterol efflux capacity in ESRD patients was significantly impaired, the function change of HDL mediated cholesterol efflux may be one of the molecular mechanisms of atherosclerosis in ESRD patients. Single hemodialysis can not improve HDL cholesterol effux capacity in ESRD patients.