Background: End-stage renal disease is becoming important to public health in developing world. Hemodialysis is a kidney function replacement therapy that removes certain toxins or metabolic waste from the bloodstream. Patients on hemodialysis for chronic renal failure encounter a variety of issues, including psychological distress, fatigue, and biochemical disturbances. The aim of the study was to assess the effect of intradialytic exercise on fatigue, psychological distress, and biochemical findings among hemodialysis children. Research design: A quasi-experimental design was used to conduct the study (study and control group pre/ posttest) was used to achieve the purpose of the study. Data were collected using the following tools (1) Pediatric quality of life inventory–multidimensional fatigue scale (PedsQL-MFS) (2) Depression Anxiety and stress scale (DASS-21) (3) Biochemical values developed by the researchers including blood samples for creatinine, blood urea nitrogen (BUN), sodium, calcium, potassium and phosphorus. The study was conducted at pediatric hemodialysis unit in Menofia University Hospital at Shebin El-Koom City, Egypt. The results revealed that there were highly statistically significant differences in children's fatigue before intervention, after four and eight weeks of intervention compared with the control group. Also, there was a highly significant difference in the total mean score of anxiety, depression, and stress after four and eight weeks of intervention between the study and control groups. Moreover, there was improvement in the mean score of blood urea nitrogen (BUN), calcium and phosphor in the study group after 4 and 8 weeks of intervention compared to before intervention. Conclusion: the study concluded that intradialytic exercise had a positive effect on fatigue, psychological distress, and biochemical findings among hemodialysis children. Recommendation: Intradialytic exercise should become a fundamental part of the total management of all patients undergoing hemodialysis.