Background: Dialysis adequacy is an important survival indicator in patients with chronic hemodialysis (HD). Intradialytic exercise in end-stage renal disease (ESRD) patients improve dialysis adequacy. Objective: This study aimed to evaluate the effect of 2 months combining of intradialytic leg cycling and upper limb range of motion exercises (ROM) on dialysis efficiency for patients with ESRD. Patients and Methods: Forty six hemodialysis patients of both sexes with ESRD participated in the study. They were randomly assigned into two groups (A & B). Group (A) included 11 males and 12 females where they received 3 sessions per week for 2 months of intradialytic leg cycling and upper limb range of motion exercise. Group (B) included 12 males and 11 females who received only upper limb range of motion exercise. Their mean age were 60.76 ± 3.37 and 60.82 ± 3.41 years old for group A & B respectively.   Results: There was a significant decrease in urea level, K⁺ and phosphorus in group A post-treatment compared to their pre-treatment (p < 0.01), while there was a significant increase in K t/V, URR and creatinine clearance post-treatment compared to pretreatment (p < 0.001). There was no significant change in urea level, URR, creatinine clearance and K⁺ in group B (p > 0.05), while there was a significant increase in K t/V and a significant decrease in phosphorus post-treatment compared to pre-treatment (p < 0.01). Conclusion: Combination of Intradialytic leg cycling and upper limb range of motion exercises had a significant role in increasing dialysis adequacy (URR & K t/V), creatinine reduction ratio and decreasing phosphorus and potassium for ESRD patients on maintenance hemodialysis.