Background. Structural abnormalities of the common carotid artery (CCA), as assessed by ultrasound techniques, are related to cardiovascular outcome in dialysis patients. An increased intima media thickness (IMT) of the CCA may both represent a reaction to a haemodynamic burden as well as atherosclerosis. With a new ultrasound technique CCA-IMT and IMT-inhomogeneity, a novel parameter of spatial variance of the IMT, were measured and related to traditional and non-traditional risk factors. Methods. In a cross-sectional study, we included 134 dialysis patients, aged 61 +/- 13 years (103 on haemodialysis, 31 on peritoneal dialysis) and 41 controls, aged 60 +/- 8 years. Age, sex, pulse pressure, diabetes, prevalent cardiovascular disease (CVD) and height were included in the basic multiregression analysis. Ultrasound examination of the CCA was performed. We also measured serum fetuin-A, high-sensitivity C-reactive protein (hsCRP), antibodies to oxidized low density lipoproteins (anti-oxLDL antibodies), calcium, phosphate, albumin and parathyroid hormone. Results. Compared with controls, dialysis patients had a greater CCA-IMT (670 mu m vs 590 +/- 10 mu m; P = 0.002) and a greater CCA-IMT inhomogeneity (11.0 vs 8.1%; P = 0.013). Dialysis patients with CVD had a greater CCA-IMT (734 mu m vs 631 mu m; P = 0.001) and IMT-inhomogeneity (13.2 vs 9.7; P = 0.008) compared with patients without CVD. IMT-inhomogeneity strongly correlated with IMT (R = 0.65, P <0.0001). In multiregression analysis, serum fetuin-A and anti-oxLDL antibodies correlated with IMT-inhomogeneity but not with IMT. HsCRP neither correlated with IMT-inhomogeneity nor with IMT. Conclusion. The present study shows that CCA-IMT and IMT-inhomogeneity were increased in dialysis patients compared with controls. Although CCA-IMT and IMT-inhomogeneity are related, the different associations between both measurements and non-traditional risk factors show that they are distinct entities.