Background: Cardiovascular disease is major cause of death in patients with end-stage renal disease (ESRD). Therefore, early detection of coronary artery disease (CAD) is important to improve outcome of ESRD patients. The purpose of this study was to investigate the diagnostic accuracy of DSCT angiography (DSCTA) compared with conventional coronary angiography (CAG) in patients with ESRD. Methods: Eighteen ESRD patients who had significant coronary stenosis of more than one vessel on DSCTA and underwent CAG were selected. Control group (n=38) was composed of age- and sex-matched individuals with normal renal function. Epicardial coronary arteries were analyzed as 9 segments with exclusion of branches. Significant stenosis was defined as a diameter stenosis of >50%. To evaluate coronary artery calcium, Agatston score was measured on DSCT. We compared DSCTA and CAG to assess sensitivity, specificity, false positive and negative rate, and positive and negative predictive values. Results: Age and sex were comparable in the two groups (age, 65짹12 vs. 69짹10, p=0.181; male, 61.1% vs. 57.9%, p=0.527). Agatston score was significantly higher in ESRD group (825.1짹1297.6 vs. 300.5짹421.0, p=0.029). The numbers of vessels with significant stenosis on DSCTA were similar in both groups (1.8짹0.8 vs. 1.7짹0.8 p=0.747). Positive predictive value of DSCTA about coronary artery stenosis was also similar in both groups (75.0% vs. 89.5% p=0.170). However, on per-segment analysis, false positive rate of DSCTA was significantly higher in patients with ESRD group (87.5% vs. 39.5% p=0.001) and number of segments showing false positivity was also higher in ESRD group than in control (2.0짹1.6 vs. 0.5짹0.7, p<0.001). In both groups, similar portion of patients had calcified plaques in segments showing false positivity (71.4% vs. 68.8%, p=0.596). Conclusion: Because of severe coronary artery calcification in patients of ESRD, false positive rate of DSCTA was higher than that of patients with normal renal function. Larger trial is needed to suggest more specified considerations for DSCTA in patients with ESRD.