* Cardiovascular disease (CVD) is the leading cause of mortality in hemodialysis (HD) patients.
* Carotid intima-media thickness (CIMT) is a validated surrogate marker for atherosclerosis.
* Both traditional cardiovascular risk factors (hypertension, diabetes, dyslipidemia) and dialysis-specific factors (mineral metabolism disorders, dialysis duration) contribute to vascular damage.
* Gap in knowledge: Few studies have comprehensively assessed the combined impact of these factors on CIMT in HD patients.