Background: Left ventricular hypertrophy (LVH) is a reaction to increasing cardiac activity that is usually due to combined pressure and volume overload, resulting in cardiac muscle hypertrophy and increasing intercellular matrix. In newly diagnosed hemodialysis (HD) patients, the prevalence of LVH is 75%.  Objective: The aim of the current study is to detect early markers for LVH in HD patients. Patients and methods: A cross-sectional study included 70 HD patients divided into two groups;Group I(40 HD patients with LVH), and Group II(30 HD patients without LVH).All cases were subjected tohistory, clinical examination, completeblood count(CBC), kidney function tests, blood glucose, serum cholesterol (TC), serum triglycerides (TG), serum ferritin, CRP, serum calcium, serum phosphorus, parathyroid hormone (PTH), serum copeptin, renalase, and 2D echocardiography with estimation of left ventricular mass index (LVMI). Results: LVH is significantly associated with ischemic heart disease (IHD), older age, higher systolic blood pressure (SBP), duration of HD, lower hemoglobin, higher TG, TC, CRP, PTH, serum renalase and copeptin. A positive correlation found between serum copeptin and all of age, duration of dialysis, Left ventricular mass index (LVMI) and serum renalase. A positive correlation found between serum renalase and all of systolic, diastolic blood pressure (DBP), duration of HD, LVMI and serum copeptin. Conclusion: Serum copeptin and renalase levels are strongly associated with cardiovascular risks specially LVH and heart failure (HF) in HD patients.