Background: About one-fifth of the adult population has end-stage renal disease (ESRD), which is associated with an elevated risk of illness and death. To remove excess sodium from the body, hemodialysis treatments using dialysate sodium (D-NA) with a concentration of 120 mEq/L have been utilized for decades. Higher D-Na (around140 mEq/L) has been employed for dialysis hemodynamic stability over time. Objective: To determine the impact of decreased dialysate Na (equal to or less than 135 mEq/L) on cardiac functions and different echocardiographic parameters in prevalent hemodialysis patients. Patients and Methods: At Rod Elfarag Hospital's Dialysis Unit, 45 patients on regular hemodialysis underwent a 6-month prospective study. Results: This study found a significant difference between baseline and six-month lab results in terms of hemoglobin, WBCs, platelets and Ht/URR as well as serum albumin and Ca/Na/phosphorus and BNP (p < 0.001). We discovered a highly statistically significant variation in PR interval, QRS duration, and QT interval between the baseline and follow-up ECGs after six months (p < 0.001). There was high statistically significant difference between baseline echocardiography and after 6 months echocardiography as regard left atrium diameter, ejection fraction (EF%), diastolic blood pressure (DBP) and systolic BP (p < 0.001). Conclusion: Our results showed that the PR interval, QRS duration, and QT interval at baseline were all statistically significantly different from those after six months of treatment. DBP couldn't be lowered in this short time frame at all. This strategy's impact should be investigated in depth over an extended period of time.