Objective To investigate the correlation of hyperphosphatemia with cardiovascular parameters, left ventricular hypertrophy (LVH) and aortic calcification (AC), in chronic kidney disease (CKD) patients undergoing maintenance hemodialysis. Methods A total of 465 CKD patients on dialysis admitted to the First Affiliated Hospital of Chongqing Medical University from January 2018 to March 2019 were enrolled in this retrospective study. Their baseline data, laboratory indicators, two-dimensional echocardiogram, chest CT plain scan, and chest X-ray films were collected. For the 328 patients who received two-dimensional echocardiography, they were divided into LVH group (n=234) and non-LVH group (n=94) based on the presence or absence of LVH. While, the 330 patients who underwent chest CT plain scan or chest X-ray examination were divided into AC group (n=199) and non-AC group (n=131). The 269 patients who underwent both two-dimensional echocardiography and chest CT plain scan or chest X-ray examination were divided into low, normal and high serum phosphorus groups (serum phosphorus level:<0.81,0.81-1.45, >1.45 mmol/L; n=36,106, 127, respectively). SPSS statistics 26.0 was used for data analysis. Depending on data type, student′s t test, Mann Whitney U test, or Chi-square test was used for intergroup comparison. Multivariate logistic regression model was performed to analyze the relationship of serum phosphorus level with LVH and AC. Results The LVH group had significantly older age [(49.25±13.52) vs (52.78±12.34) years], higher systolic blood pressure [(150.80±25.19) vs (144.00±24.94) mmHg (1mmHg=0.133kPa)], diastolic blood pressure [(85.50±18.18) vs (79.96±14.80) mmHg] and serum phosphorus level [(1.97±0.76) vs (1.73±0.73) mmol/L], and larger proportion of diabetes [25.21% (59/234) vs 15.96% (15/94)], but obviously lower hemoglobin [(98.51±26.10) vs (107.05±26.48) g/L], serum calcium [(2.07±0.29) vs (2.16±0.31) mmol/L] and albumin [(38.09±5.94) vs (39.74±5.77) g/L] when compared with the non-LVH group (all P<0.05). Statistically older age [(57.82±10.32) vs (45.87±11.75) years], higher hemoglobin [(102.22±24.57) vs (94.55±28.16) g/L], serum calcium [(2.16±0.28) vs (2.00±0.31) mmol/L], serum phosphorus [(1.99± 0.76) vs (1.81±0.74) mmol/L], calcium phosphorus product [(52.70±20.02) vs (44.54±18.42) mg/dl] and proportions of diabetes [28.64% (57/199) vs 15.27% (20/131)] and hypertension [28.64% (57/199) vs 15.27% (20/131)], and lower diastolic blood pressure [(81.67±15.00) vs (87.31±19.35) mmHg] and usage rate of phosphorus lowering drugs [39.70% (79/199) vs 55.73% (73/131)]were observed in AC group than in non-AC group (all P<0.05). Multivariate logistic regression analysis showed that increased diastolic pressure (OR=1.017,95% CI 1.001-1.033; P=0.038), increased serum phosphorus (OR=1.581,95%CI 1.080-2.316; P=0.019), diabetes mellitus (OR=0.540,95%CI 0.296-0.987; P=0.045) and decreased albumin (OR=0.934,95%CI 0.891-0.979; P=0.004) were independent risk factors for LVH in maintenance hemodialysis patients. Age (OR=1.091,95%CI 1.067-1.117; P<0.001), elevated serum phosphorus (OR=0.307,95% CI 0.128-0.734; P=0.008), calcium phosphorus product (OR=1.085,95%CI 1.046-1.125; P<0.001), and diabetes mellitus(OR=2.039,95% CI 1.041-3.995; P=0.038) were independent risk factors for AC in these CKD patients on maintenance hemodialysis. The incidence of LVH was significantly higher in the high serum phosphorus group than the normal serum phosphorus group [80.31% (102/127) vs 61.32% (65/106); P<0.05]. Conclusion Hyperphosphatemia is an independent risk factor for LVH and AC in CKD patients undergoing maintenance hemodialysis. Controlling hyperphosphatemia is essential to improve cardiovascular disease in CKD patients.