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Objective. We have shown that regression of brachial stiffness is inversely related to aortic stiffness in dialysis patients. In this study, we sequentially examine the impact of aortic stiffness, brachial stiffness and aortic-brachial stiffness mismatch on mortality in dialysis patients. Design and Method. This is a prospective longitudinal study conducted in 310 adult dialysis patients (mean age 65 ± 15). Aortic and brachial stiffness were respectively measured by determination of carotid-femoral (cf-PWV) and carotid-radial pulse wave velocity (cr-PWV) (CompliorSP-direct measurement technique). Aortic-brachial stiffness mismatch was defined by cf-PWV/cr-PWV mismatch. Central pulse wave profile was determined by radial applanation tonometry. After a mean follow-up of 3.6 ± 1.7 years mortality status was assessed. ROC curve analysis was performed to evaluate the impact of central pulse pressure (PP), heart rate adjusted augmentation index (AIx), cf-PWV, cr-PWV and the cf-PWV/cr-PWV ratio on mortality. Results. The cf-PWV was 13.5 ± 4.1 m/s, cr-PWV was 8.7 ± 1.7 m/s, cf-PWV/cr-PWV ratio was 1.6 ± 0.5, central PP was 49 ± 21 mmHg and the AIx 26.8 ± 11.1%. During follow-up, 160 (49%) deaths occurred. Area under the curve was largest for cf-PWV/cr-PWV ratio (0.694, p < 0.001), followed by cf-PWV (0.627, p < 0.001), AIx (0.617, p < 0.001), PP (0.598, P = 0.003) and cr-PWV (0.371, p < 0.001). Figure 1 shows patient survival according to tertiles of aortic-brachial stiffness ratio. In univariate and various adjusted models using Cox regression model, aortic-brachial stiffness was independently associated with increased risk of mortality. Conclusion. Aortic-brachial stiffness mismatch was better that aortic stiffness alone in predicting clinical outcome in this population.