Background : Insulin resistance (IR) is an independent predictor of cardiovascular morbidity and mortality in end‐stage renal disease (ESRD) patients. This study was to investigate the association between IR and cardiovascular disease (CVD) risk factors among ESRD patients undergoing hemodialysis. Methods : A clinical cross‐sectional study was conducted on 384 HD patients aged 20 years and above, from seven dialysis centers. Biochemical parameters were analyzed from the 8‐hour pre‐prandial and pre‐dialysis blood samples by using the automated and standardized methods. Homeostatic Model Assessment of Insulin Resistance (HOMA‐IR) was used as an indicator of IR. The CVD risk factors were defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines. Logistic regression analysis was used. Results : Patients' age was 60.9 ± 11.8, 58.1% men, and 40.3% overweight or obese. The prevalence of high HOMA‐IR was 71.6%. The traditional CVD risk factors included high SBP (82.8%), high DBP (25.5%), high TC (16.7%), high LDL‐C (48.4%), low HDL‐C (65.9%), high TG (40.6%), and impaired fasting glucose (69.5%). The non‐traditional CVD risks included anemia (58.3%), low calcium (8.3%), high calcium (35.2%), low phosphorus (7.0%), high phosphorus (35.4%), high calcium‐phosphorus product (25.5%), high intact parathyroid hormone (42.7%), hyperhomocysteinemia (85.7%), elevated high sensitive C‐reactive protein (45.6%), and low serum albumin (12.0%). After controlled for age, gender, hemodialysis vintage, Charlson Comorbidity Index, Physical activity, and body mass index, elevated level of HOMA‐IR was significantly associated with higher low HDL‐C (OR = 2.23, 95%CI = 1.38 to 3.61, P = .001), high TG (OR = 2.95 [1.71 to 5.10], P < .001), IFG (OR = 7.95 [4.65 to 13.59], P < .001), and hypoalbuminemia (OR = 6.72 [2.01 to 22.44], P = .002). Conclusions : Hemodialysis patients were with the high prevalence of insulin resistance, and CVD risk factors. Higher HOMA‐IR was associated with higher CVD risk factors.