Objective To investigate the influencing factors of coronary artery calcification (CAC) in patients with chronic kidney disease (CKD). Methods A total of 181 CKD patients undergoing multi-slice spiral computed tomography for coronary artery were selected. The patients were divided into four groups of CKD 1 stage, CKD 2-3 stage, CKD 4-5 stage and maintenance hemodialysis (MHD) according to the kidney disease outcome quality initiative (K/DOQI) guidelines established by the National Kidney Foundation. According to the CAC scores assessed using the Agatston scoring method, the patients were divided into non-CAC group (CAC score ≤ 10), mild CAC group (CAC score 11-100), moderate CAC group (CAC score 101-400), and severe CAC group (CAC score>400). The related factors and independent influencing factors of CAC in CKD patients were analyzed by Spearman linear regression analysis and multivariate Cox regression analysis, respectively. Results Of the 181 patients, 44 were CKD 1, 36 were CKD 2-3, 25 were CKD 4-5, and 76 were MHD. The incidence of CAC in the CKD patients and MHD patients was 55.3% (100/181) and 80.3% (61/76), respectively. The CAC score of CKD patients was significantly increased with the aggravation of renal impairment (r=0.526, P<0.001). The degree of CAC in the CKD patients was positively correlated to age, dialysis duration, average arterial pressure, blood urea nitrogen, serum creatinine, C-reactive protein, total cholesterol, serum calcium, serum phosphorus, calcium-phosphorus product, and serum fibroblast growth factor 23 (FGF23) level (r=0.135, 0.525, 0.139, 0.141, 0.824, 0.135, 0.140, 0.138, 0.391, 0.453, and 0.326; all P<0.05), and negatively correlated to estimated glomerular filtration rate (eGFR), fetuin A, and 25-hydroxy vitamin D₃ (r=-0.871, -0.135, and -0.138; all P<0.05); the degree of CAC was not significantly correlated with hemoglobin, blood glucose, triglyceride, alkaline phosphatase, or intact parathyroid hormone (all P>0.05). Multivariate Cox regression analysis showed that age, eGFR, serum phosphorus, calcium-phosphorus product and serum FGF23 level were the independent influencing factors of CAC in CKD patients (OR[95% CI]:3.723[2.521-8.363], 0.582[0.415-0.724], 5.252[0.415-0.724], 11.243[10.185-16.836], and 2.469[1.141-5.362]). Conclusion Age, eGFR, serum phosphorus, calciumphosphorus product and serum FGF23 level are independent influencing factors of CAC in CKD patients.