Aim To explore association of epicardial adipose tissue (EAT) with coronary artery calcification and chemerin in maintenance hemodialysis (MHD) patients. Methods 90 MHD patients in Tianjin Fifth Central Hospital were included in the study. MHD patients were divided into low-risk (＜10% ), mid-risk (10%~20%) and high-risk group (＞20%) according to Framingham risk score (FRS). 60 normal subjects were selected as control group. Serum chemerin, C-reactive protein (CRP), blood routine and biochemistry were determined, multi-slice spinal CT examination were underwent. The EAT volume and coronary artery calcium score (CACS) were calculated with the Philips workstation. The relationship of EAT volume with CACS, serum chemerin, CRP, FRS were analyzed. Results Serum chemerin, CRP and neutrophil to lymphocyte ratio were significantly higher in MHD group compared to control group (all P＜0.01). EAT volume, CACS and serum chemerin were significantly higher in high-risk group and in mid-risk group compared to those in low-risk group (P＜0.05 or P＜0.01), EAT volume, serum chemerin were significantly higher in high-risk group compared to those in mid-risk group (all P＜0.05). The multivariate linear stepwise regression showed that CACS, serum chemerin, CRP, FRS were the influencing factors of EAT(P＜0.05 or P＜0.01). ConclusionSerum chemerin, CRP and neutrophil to lymphocyte ratio were significantly higher in MHD patients. There was microinflammation in MHD patients. In MHD patients, EAT volume, CACS and serum chemerin in high-risk group and in mid-risk group were both higher than those in low-risk group. CACS, serum chemerin, FRS were correlated with EAT volume.EAT might be used as predictors of cardiovascular risk in MHD patients.