Objective: To explore the occurrence and progress of abdominal aortic calcification (AAC) in patients with chronic kidney disease (CKD) at stage 3–5 undergoing maintenance hemodialysis, and analyze its influencing factors. Methods: A total of 80 CKD patients at stage 3–5 who underwent maintenance hemodialysis in Fuyang Second People’s Hospital from January 2017 to March 2018 were enrolled. The risk factors that affected the occurrence and progress of AAC were analyzed. Results: Among the 80 CKD patients at stage 3–5 undergoing maintenance hemodialysis, there were 44 cases without calcification and 36 cases with calcification. The results of Logistic regression analysis showed that age, histories of hypertension, diabetes, coronary heart disease, C-reactive protein, serum phosphorus, triacylglycerol and intact parathyroid hormone were independent risk factors of AAC occurrence, while 25-hydroxyvitamin D was a protective factor. They were followed up for 2 years and 67 patients were followed up with X-rays reexamination at the abdominal lateral side, including 32 cases (14 new onset cases) in AAC progress group and 35 cases in non-AAC progress group. The results of Logistic regression analysis showed that age, serum phosphorus, C-reactive protein, triacylglycerol and intact parathyroid hormone were independent risk factors of AAC progress, while 25-hydroxyvitamin D and high-density lipoprotein were protective factors. Conclusion: Age, serum phosphorus, histories of hypertension, diabetes, coronary heart disease, high level of C-reactive protein, low levels of 25-hydroxyvitamin D, triacylglycerol and intact parathyroid hormone affect the occurrence of AAC in hemodialysis patients, independently while high-level serum phosphorus, low-level 25-hydroxyvitamin D, high-level triacylglycerol, high-level intact parathyroid hormone and low-level high-density lipoprotein cholesterol affect the progress of AAC independently.