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Calciprotein particles (CPPs), nano-aggregates containing fetuin-A-bound calcium-phosphate, are associated with aortic stiffness and coronary calcification in maintenance hemodialysis patients. A novel gel-filtration assay can detect low-density small CPPs, which are actually a major form of circulating CPPs in vivo. We sought to investigate whether circulating CPP levels measured by gel-filtration method would accurately predict hard endpoints in maintenance hemodialysis patients.This study used a prospective, multicenter, longitudinal, and observational design. One-hundred eight patients enrolled in this study were followed-up for about 2 years. We reported all-cause death and cardiovascular events, which included major adverse cardiac, cerebrovascular, and limb events.Kaplan-Meier analysis showed no significant difference between patients with the higher (median) and lower (median) CPP levels with regard to all-cause death. However, the higher CPP group showed a higher incidence of cardiovascular events (log-rank test χThis finding suggests a potential predictive value of CPPs in maintenance hemodialysis patients.