Aim To analyze the clinical characteristic of coronary artery calcification (CAC) in patients with maintenance hemodialysis (MHD) and search for noninvasive serological markers for evaluating CAC. Methods 148 MHD patients were selected as the research subjects. The coronary artery calcification score (CACS) was evaluated by multi-slice spiral CT (MSCT) to judge the CAC status. According to CACS, patients with MHD were divided into three groups (CACS＜100 group, 100≤CACS≤400 group, CACS＞400 group). Compare the differences of serum irison, sclerostin (SOST), hypoxia inducible factor-1α (HIF-1α), fetuin A and general clinical data in the three groups. Spearman correlation was used to analyze the correlation between the degree of CAC and each index. Logistic regression analysis was used to analyze the risk factor of CAC in MHD patients. Receiver operating characteristic (ROC) curve was used to search for non-invasive serological indicators for diagnosis and evaluation of CAC in MHD patients. Results The prevalence of CAC (CACS＞100) in 148 MHD patients was 62.8% (93/148). There were statistical differences in irisin, SOST, serum phosphate, age, total cholesterol, triglyceride, low density lipoprotein cholesterol and uric acid among the three groups (P＜0.05), while there were no differences in HIF-1α and fetuin A (P＞0.05). Spearman correlation analysis showed that the degree of CAC was positively correlated with SOST, age, body mass index, total cholesterol, triglyceride, low density lipoprotein cholesterol, blood phosphorus, calcium-phosphorus product (P＜0.05), and negatively correlated with the level of irisin (P＜0.05). Multivariate Logistic regression analysis showed that serum triglyceride, SOST and irison level was independent risk factor for CAC(P＜0.05). ROC curve analysis showed that irisin and SOST had high diagnostic value for MHD patients complicated with CAC. Conclusion Serum irisin and SOST are expected to be non-invasive serological indicators for the diagnosis and evaluation of the severity of CAC.