Abstract Background: End stage renal disease (ESRD) patients are at increasing risk for hepatitis B virus (HBV) infection, also they are considered immunocompromised and their response to vaccination is low compared to normal persons. Aim of Study: The aim of our study is to determine the immunological response after HBV vaccination, and its relation to dialysis prescription dose in hemodialysis (HD) patients. Patients and Methods: This cross sectional study included 100 ESRD patients on maintenance HD, selected from dialysis units of Shebin Elkom Teaching Hospital, Menoufia Gover-norate and Ain Shams University Hospital, from November 2019 to November 2020. All patients were ESRD on thrice weekly HD sessions, 3-4 hours for each session using bicar-bonate dialysate and polysulfone dialyzers. The blood flow rate ranged from 220-350ml/min, the dialysate flow rate was 500ml/min. All patients were negative for serological markers of HBV infection, including HBsAg and anti-HBc antibodies. The study included 59 males and 41 females. Their ages ranged between (23-76 years). 14 Patients received 4 doses of hepatitis B vaccine with dose 2.0 mL, administered at 0, 1, 2 and 6 months by intramuscular (deltoid) injection (ac-cording to infection control program in dialysis units in Egypt), 86 patients previously completed their course of vaccination so received a booster dose then HBV antibody titer was measured a month after for both groups. Results: Eighty-eight patients (88%) mounted a response with HBsAb >10 mIU/ml, and thus were considered as ade-quate responders. 54 patients out of responders (61.4%), mounted a high response with HBsAb >1000mIU/ml. Twelve patients (12%) were non-responders. Age, gender, anthropo-metric measures, hemoglobin level, serum albumin, ferritin, parathyroid hormone (PTH) level and hepatitis C virus infec-tion had no effect on the response to the vaccine. Similarly, there was no difference in diabetic state between the two groups. There were highly significant differences between responders and non-responders regarding dialysis adequacy [urea reduction ratio (URR) and KT/V] and CRP. Conclusion: There was a high response to HBV vaccine in ESRD patients and there were significant relations between dialysis adequacy in the form of URR and KT/V and CRP and HBV antibody titer.