Background: Chronic kidney disease (CKD) is a worldwide public health problem. Fetuin A is a natural calcium antagonist. Both human and animal studies have shown that low circulating fetuin A level are associated with vascular calcification and may be an independent risk factor for premature death in CKD patients. Objective: The aim of this study was to evaluate the effect of serum fetuin-A in the pathogenesis of chronic kidney disease and its correlation with routine renal biomarkers.Patients and methods: The study population was divided into 3 groups. Group I: Pre-dialysis group: on conservative treatment. Group II (CKD): on regular hemodialysis, 3 sessions/week for more than 9 months. Group III (Control group).Results: There was significant negative correlation between blood urea, serum creatinine versus serum fetuin-A in conservative group with arterial stiffness. There was significant positive correlation between eGFR and serum fetuin-A in conservative group with arterial stiffness, while there was no significant correlation between serum fetuin-A and Hb, HcT, platelets, WBCS, FBS, Na + , K + , PO4 -2 , serum uric acid, total bilirubin, ALT, AST, ALP, serum albumin and prothrombin time. There was significant negative correlation between serum Ca +2 and serum fetuin-A. There was significant negative correlation between total cholesterol as well as triglycerides versus serum fetuin A.Conclusion: serum fetuin-A level significantly reduced in hemodialysis patients, significantly correlated with the disease duration, and negatively correlated with serum Ca, T. cholesterol, and T.G.