Aim To explore the relationship between Runx2 methylation level and vascular calcification in maintenance hemodialysis (MHD) patients. Methods 58 patients who underwent MHD in the Fourth Hospital of Hebei Medical University were selected as the research objects. The clinical data of the patients were collected. According to the coronary artery calcification (CAC) score, the patients were divided into non-calcification group, mild to moderate calcification group, and severe calcification group. Methprimer was used to design Runx2 methylation primers, methylation-specific PCR was used to detect the level of Runx2 methylation in the whole blood of patients, and Spearman correlation analysis was used to explore its relationship with vascular calcification. Receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of Runx2 methylation level for vascular calcification in MHD patients. Results The difference test found that the Runx2 methylation level difference between the three groups was statistically significant.And as the degree of vascular calcification increased, the expression level of Runx2 methylation decreased. Spearman correlation analysis showed that the methylation level of Runx2 was negatively correlated with vascular calcification (r＝－0.51, P＜0.01), age and serum phosphorus were positively correlated with vascular calcification (P＜0.05). ROC curve analysis showed that the area under the ROC curve (AUC) for the diagnosis of vascular calcification by Runx2 methylation level was 0.761 (P＜0.001). The AUC and sensitivity of the diagnosis of vascular calcification in combination with Runx2 methylation level, age and blood phosphorus were significantly improved (P＜0.05). Conclusion Runx2 methylation level may be a biomarker for the diagnosis of vascular calcification in patients with MHD, and the AUC and sensitivity are significantly improved when combined with age and blood phosphorus.