Background. Recently, careful attention has been paid to multiple risk factor syndromes, such as syndrome X, insulin-resistance syndrome, and visceral-fat syndrome, in terms of the development of coronary artery disease, which is also the major cause of death in hemodialysis patients. The purpose of this study was to evaluate the impact of visceral fat accumulation on these multiple risk factors in hemodialysis patients. Methods. Seventy-two stable outpatients (35 men, 37 women) participated in this study. After determination of the visceral fat area and the subcutaneous fat area by a computed tomography scanning technique, they were classified into two groups according to the value of the visceral fat area. Fasting blood samples were drawn for lipid and carbohydrate data. Results. The high-visceral fat group exhibited a significantly (1) higher insulin resistance index, (2) higher level of triglyceride, (3) lower level of high-density lipoprotein cholesterol, and (4) a higher atherogenic index, in comparison with the low-visceral fat group. Moreover, they had (5) a higher frequency of a history of coronary artery disease (33.3% vs 8.3%; P < 0.01). These findings are completely in accordance with the visceral fat syndrome. Conclusions. Visceral fat accumulation in hemodialysis patients has effects on lipid and carbohydrate metabolism, and it may increase the risk of coronary artery disease.