Vascular calcification is associated with poor prognosis in hemodialysis (HD) patients. It can be assessed with computed tomography (CT) but simple in-office techniques may provide useful information. We compared the results obtained with a simple non-invasive technique with those obtained using multi-detector CT (MDCT) for aortic arch calcification volume (AoACV) in chronic HD patients. The aortic arch calcification score (AoACS) estimated by chest X-ray was highly correlated with AoACV. In another cohort study, during a follow-up period of 4.0 years, the patients with and without AoAC, 11.3% and 6.6% of cardiovascular diseases, respectively were studied. Kaplan-Meier analysis showed that cardiovascular mortality was significantly greater in patients with AoAC compared with those without it. Multivariate Cox proportional hazards analysis found that the presence of AoAC was significantly associated with increased cardiovascular mortality (hazard ratio, 2.556; 95% confidence interval, 1.006 to 6.490; P < 0.05) after the adjustment for age, presence of diabetes, body mass index, diastolic blood pressure, and serum albumin level. Finally, we found that nonprogressors were significantly younger than the progressors (p=0.0419) in changes in AoACS (ΔAoACS). The prescribed dose of 1α-hydroxy vitamin D3 was significantly higher in the non-progressors than progressors. Multiple regression analysis revealed prescribed dose of 1α-hydroxy vitamin D3 to be significant independent determinant of ΔAoACS. In conclusion, the evaluation of AoACS on chest radiography is a very simple tool for the detection of AoAC in HD patients. Active vitamin D therapy seems to protect patients from developing vascular calcification in chronic HD patients.