Background: Few studies including limited number of patients assessed the rheumatologic effects of hemodialysis (HD) on joints using ultrasonography. Joint ultrasound has been emerged as a cheap non-invasive tool for assessment of joint pain among HD patients. This was the aim of our study to make use of such tool in such life quality threatening complaint. Objective: to determine the role of ultrasound in evaluation of joint pain and its causes among patients on regular HD. Patients and Methods: One hundred and four patients with end stage renal disease (ESRD) who were regular on HD three sessions per week four hours per session were subjected to history taking, complete physical examination stressing on musculoskeletal examination and ultrasonography of painful joints by an ultrasonography expert. Results: Dialysis related arthropathy (DRA) was not the only cause of joint pain among HD patients but there were diverse causes in different joints. As regard affected joints, knee was the most affected one then came wrist, shoulder, ankle and elbow respectively. As regard causes of joint pain, DRA was the commonest one then came osteoarthritis, non-specific ultrasonographic findings and few cases showed normal ultrasonographic studies. Conclusion: This study confirmed that joint pain in HD patients has diverse causes not DRA by necessity but other causes must be considered as well as multifactorial etiologies.