Background: end-stage renal disease is a global public health burden bearing high morbidity and mortality, and cardiovascular disease is a major cause of mortality in hemodialysis patients. Objective: the aim of this study is detection of arrhythmia and blood pressure variability in hemodialysis (HD) patients. Patients and Methods: this prospective observational study included 100 chronic renal failure patients on regular HD came to the hemodialysis center of Al-Azhar University Hospital, New Damietta and Kafr Elsheikh General Hospital. The study was carried out over a period of eight month from July 2017 until September 2018. Results: the intradialytic (ID) blood pressure was normal in 38%, ID hypertension was reported in 44% and ID hypotension was reported in 18% of HD patients, also we found that arrhythmia was developed in 84% of HD patients and the prevalence of arrhythmia was VES in 56%, PAC in 50%, SVT in 4%, AF in 8.0%, sinus tachycardia in 26% and sinus bradycardia in 20%. The sympathetic over activity (LF/HF ratio < 1.5) was reported in 38%; and high risk standard deviation of normal-to-normal intervals (SDNN) was reported in 22% and moderate risk in 70.0% while low risk was reported in 8.0% of HD patients. Conclusion: cardiac arrhythmias are common findings in patients with chronic renal failure on regular hemodialysis.