Aim To investigate the correlation between insulin resistance and atherosclerosis in non-diabetic continuous ambulatory peritoneal dialysis (CAPD) patients. Methods Sixty-four non-diabetic CAPD adult patients were enrolled in this study. The clinical data including insulin resistance index (HOMA-IR) of 63 patients on CAPD was analyzed. The bilateral common carotid artery intima-media thickness (IMT) and carotid artery atheromatous plaque were measured by high resolution two-dimensional ultrasonic diagnostic apparatus. Patients were divided into two groups:non-atherosclerosis group (IMT＜1.0 mm) and atherosclerosis group (IMT≥1.0 mm or atheromatous plaque). Results Compared with the patients in non-atherosclerosis group, the level of plasma albumin in the patients in atherosclerosis group was lower (P＜0.01), but the levels of 2h PBG, HOMA-IR, hs-CRP, TG and LDLC were significantly higher (P＜0.05).The prevalence of insulin resistance was 53.49% in atherosclerosis group, but only 4.76% in non-atherosclerosis group (P＜0.01). Linear correlation analysis showed that atherosclerosis was correlated with age, 2h PBG, HOMA-IR, hs-CRP, LDLC and TG in non-diabetic CAPD patients (r＝0.5,0.3,0.0,0.5,0.351 and 0.458, all P＜0.05). Binary Logistic regression showed that age, 2h PBG, HOMA-IR, hs-CRP were independent risk factors of atherosclerosis. Conclusions HOMA-IR is positively correlated with atherosclerosis and may be a predictor of carotid atherosclerosis in non-diabetic peritoneal dialysis patients.