Objective: to examine the prevalence of elevated cardiac troponin I level in asymptomatic and symptomatic end-stage renal disease (ESRD) patients on regular hemodialysis (HD) as a strong predictor of worse cardiovascular outcomes. Background: ESRD on regular hemodialysis patients with elevated cardiac troponin I have a higher cardiac mortality rate, it is important to detect elevated cardiac troponin I patients as predictor of worse cardiovascular outcomes. Methods: The patients were divided into three groups: Group (A): ischemic heart disease patients (IHD) with normal kidney function,Group (B): ischemic heart disease patients on regular hemodialysis,Group (C): non ischemic heart disease patients on regular hemodialysis. Results: Our study revealed elevated serum cardiac troponin I (CTnI) in group B, with normal level CTnI in other two groups (A and C). There was significant positive correlation between elevated CTnI, ejection fraction, E/A ratio and regional wall motion abnormalities. There was inverse correlation between CTnI elevation and EF%, also there was direct correlation between CTn I elevation and E/A ratio in group B. Conclusion: Troponin I was elevated in symptomatic IHD patients on regular HD and normal in IHD patients with normal kidney function and in non IHD on regular HD patients. The elevated CTnI may play in past a role in cardiomyopathies in IHD on regular HD and this could be related to some acute coronary syndromes in these patients which carries worse cardiovascular outcomes.