Aim To evaluate the relationship between the level of serum hepcidin-25 and tumor necrosis factor-α （TNF-α） and carotid artery atherosclerosis in peritoneal dialysis patients. Methods The serum level of hepcidin-25 of 178 maintenance peritoneal dialysis patients was determined by enzyme-linked immunoassay. The bilateral common carotid artery intima-media thickness （IMT） and carotid artery atheromatous plaque was measured by high resolution two-dimensional ultrasonic diagnostic apparatus. Results The serum hepcidin-25 level of the patients with carotid atherosclerosis group was higher than that without carotid atherosclerosis group and healthy controls group. The difference between the two groups was statistically significant （both P<0.01）. Linear correlation analysis of serum hepcidin-25 levels and carotid IMT was positive（r＝0.685, P＝0.001）. Multiple stepwise regression analysis showed that serum hepcidin-25 and TNF-α levels were independent risk factors for carotid IMT. Conclusions The level of serum hepcidin-25 and tumor necrosis factor-α are independent risk factors of the carotid atherosclerosis in the maintenance peritoneal dialysis patients. It suggested that the level of serum hepcidin-25 and tumor necrosis factor-α can be used as a prediction of atherosclerosis risk factors.