Objective: Peripheral vascular complications frequently seen in hemodialysis patients are associated with mortality. Fibroblast growth factor 23 (FGF23) is thought to be a phosphaturic hormone that causes mortality in hemodialysis patients. The purpose of our study was to determine the association of intact FGF23 (I-FGF23) with atherosclerotic peripheral vascular complications in patients on hemodialysis. Methods: This cross-sectional study was performed with 50 [28 (56%) male, 22 (44%) female] hemodialysis patients. Patient characteristics were compared with an age +- and sex-matched control group of 40 healthy volunteers. Atherosclerosis development was measured by carotid intima media thickness (CIMT) and arterial stiffness development was measured by brachial ankle pulse wave velocity (PWV) device. Results: Increased atherosclerosis and arterial stiffness were observed in patients with high I-FGF23 and low alpha klotho (α-KL) levels compared to healthy subjects. I-FGF23 showed an inverse and independent relationship between lipid profile. There was no relationship between I-FGF23 and atherosclerosis and arterial stiffness. Conclusion: There was no association between serum I-FGF23 and atherosclerotic peripheral vascular complications. The association between I-FGF23 and mortality may be due to cardiovascular events other than peripheral vascular complications in patients on hemodialysis.