Vascular calcium deposition in end-stage renal disease occurs commonly, but its relation to cardiovascular risk factors and fetuin-A levels in African Americans is not known. Compliant African American patients who were undergoing hemodialysis (HD; n = 17) agreed to undergo 64-slice multidetector computed tomography for the assessment of coronary artery calcium score (CACS). The relation between traditional cardiovascular risk factors (i.e., age; gender; dialysis vintage; history of diabetes; means of the previous 3 years of weekly predialysis blood pressure values and hemoglobin levels; means of monthly values of calcium, phosphorus, alkaline phosphatase, uric acid; and albumin; and means of quarterly measurements of parathyroid hormone and lipids) and fetuin-A levels and CACS was explored using univariate analyses. Serum phosphorus levels over the previous 3 years were well controlled. The CACS range was 0 to 3,877 Agatston units (mean 996, median 196). Among the tested variables, only fetuin-A was significantly and inversely associated with CACS (standardized beta = -0.64, 95% confidence interval -18.09 to -3.62, p = 0.006). There was no association between age and fetuin-A level (standardized beta = -0.02, 95% confidence interval -0.10 to 0.23). In conclusion, African-American patients who were undergoing long-term hemodialysis and with good phosphorus control exhibited a strong inverse correlation between fetuin-A level and CACS that was independent of age.