Background: Most of hemodialysis patients are unemployed and the few who are working are at risk of losing their jobs. Therefore, factors affecting employment need to be studied. Objective: Our aim was to access factors affecting employment among working-age patients on hemodialysis all over Egypt as it was not assessed before. Patients and Methods: This study was conducted between October 2012 and April 2015 in multiple hemodialysis centers by direct interview of the patients and collecting the data from the medical record in a special data collection sheet. Results: The study was conducted on 16280 hemodialysis patients in 19 Egyptian governorates. 21.2% of the patients were employed, 81.6% of the employed patients were men, and their mean age was 47.25+11.31. Hypertension was the most common etiology of end-stage renal disease (ESRD) and was the commonest comorbidity in employed patients. Employment was affected by age, gender, ESRD etiology and most comorbid conditions apart from comorbid chronic liver disease and chronic obstructive pulmonary disease. Factors affecting employment was dialysis frequency, duration, complications, dialyzer type, material, and surface area, dialysate type, dialysate Na, K and vascular access, haemoglobin (Hb) level, Ca/PO4 ratio, parathormone (PTH), iron injection, blood transfusion, erythropoietin intake, vitamin B complex intake, L carnitine intake, phosphate binders, cinacalcet and folic acid intake while Kt/v and urea reduction ratio and vitamin D supplements did not affect employment. Conclusion: Similar to the other studies we found that employment was not common among hemodialysis patients, which was affected by age, gender, ESRD etiology and comorbidities apart from chronic obstructive pulmonary disease (COPD) and chronic liver disease (CLD) which differed from other studies.