Background Oxidative stress is a new risk factor for atherosclerosis. Increased oxidative stress in hemodialysis (HD) patients may arise from uremia-associated metabolic/humoral abnormalities and bioincompatibility of dialysis. Patients with diabetes mellitus (DM) may be subject to an additional risk. Respective influences of uremia, diabetes, and HD duration in accelerated atherosclerosis and oxidative stress have not been clarified yet. Methods The study was performed on 24 nondiabetic HD patients, 23 diabetic HD patients, 20 stages 3 to 4 chronic kidney disease patients, and 21 diabetic patients without overt nephropathy. Carotid intima-media thickness, a surrogate of atherosclerosis, was measured by high-resolution B-mode ultrasonography. Oxidant status was determined by lipid peroxidation as expressed by malondialdehyde (MDA); antioxidant status was determined by superoxide dismutase, catalase, glutathione peroxidase, reduced intracellular glutathione, and plasma thiol. Results Intima-media thickness (IMT) was higher in patients undergoing HD but not different between nondiabetic HD patients and diabetic HD patients. No correlation was found between the duration of HD and intima-media thickness. Antioxidants were generally lower in HD patients. Intima-media thickness was positively correlated with MDA and negatively correlated with plasma thiol. Among other risk factors, only age was correlated with intima-media thickness. Conclusions Increased carotid IMT in HD patients is independent of duration of HD or diabetes status. Age and MDA are the significant predictors of carotid IMT. Increased oxidative stress due to impaired antioxidant mechanisms, particularly reduced plasma thiol redox potential, may account for accelerated atherosclerosis in high-risk patients with chronic kidney failure and/or DM.