Background: Chronic kidney disease patients usually experience several comorbid conditions including cardiovascular disorders and at final end-stage renal disease (ESRD) stage, cardiovascular mortality accounts for about 50% of total mortality. End-stage renal disease (ESRD) patients commonly have a higher risk of developing cardiovascular diseases than general population. Objective: The aim of the work was to detect the incidence of atrial fibrillation (AF) in hemodialysis patients for six months. Patients and Methods: The study was a prospective cohort study for six months included 250 adult patients with end stage renal diseases on regular hemodialysis sessions in National Institute of Urology and Nephrology in Cairo, Egypt for at least six months with no past history suggestive of any arrhythmias and normal holter ECG at the start of the study. Results: The study included 250 patients, of them 37 patients refuse follow up after 6 months and 18 patients were died before our follow up holter ECG so mortality rate 14.4%. For the current study population, there were 102 male patients (52.3%) and 93 female patients (47.7%) with mean age 54.39 ± 9.98 (19:73) and BMI 29.01±1.28 (24.5:34). In study population 96 patients were diabetic (49.2%), 84 patients were hypertensive (43.1%), 100 patients were with ischemic heart diseases (51.3%) with median renal replacement duration 4 (3 – 6) with range (1 – 13). The main etiological causes of dialysis were diabetes mellitus, hypertension and analgesic nephropathy and other different causes of dialysis 35 patients (45%).The study showed association between incidence of AF in hemodialysis patients and different factors as increased BMI (0.006), prolonged duration of renal replacement therapy (0.017), diabetes mellitus (0.005), hypertension (0.000), ischemic heart diseases (0.02) and left atrium dilation (0.000). Conclusion: It could be concluded that the incidence of AF in patients with ESRD is 16.4% .The risk factors for increased incidence of AF in hemodialysis are; increased BMI, increased duration of renal replacement therapy, hypertension, diabetes mellitus, ischemic heart diseases and left atrium dilation by echocardiography.