Background: hypoalbuminemia is an important risk factor of hypotension during hemodialysis and progressive left ventricular hypertrophy in patients with chronic kidney disease (CKD). Aim of the study: this study was done to evaluate the relationship between serum albumin and intradialytic hypotension (IDH) and cardiac functions. Patients and Methods: forty patients on regular hemodialysis (HD) were included in the present study. They have been divided into two groups; Group 1: Patients of this group developed recurrent attacks of IDH and Group 2: Patients of this group not developed IDH. The patients have been classified again according to serum albumin level into two groups; Group A: Hypoalbuminemic patients and Group B: Non-hypoalbuminemic patients. Data collected from each patient included: (1) Demographic features (age, gender) and clinical features (blood pressure changes during session, ultrafiltration rate, cardiothoracic ratio, duration of dialysis and Kt/V); (2) Blood chemistry (creatinine, urea, hemoglobin, hematocrit value, total proteins, albumin, triglycerides, cholesterol, AST, ALT, Kt/V, and fasting blood sugar); and (3) Echocardiographic assessment of left ventricular geometry. Results: there was a significant negative correlation between serum albumin and Delta BP in HD patients. Also we found no significant changes in cardiac functions among different studied groups. Conclusion: We concluded that there was a relationship between low serum albumin and intradialytic hypotention and cardiac functions in CKD patients undergoing HD. Recommendations: Regular assessment of serum albumin is mandatory for all HD patients.