Background: End-stage renal disease (ESRD) is an increasing health problem worldwide.  Older age, diabetes mellitus and hypertension, acute kidney damage are among some of the factors that play a role in ESRD. This study aims at exploring liver morbidity (LM) among Egyptian hemodialysis (HD) patients.  Methods: The study included 142 patients free from overt hepatitis B virus (HBV) or  hepatitis C virus (HCV); their data were retrieved from files and all were clinically assessed and tested for liver functions, serological markers and viremia of HCV and HBV. Results: Of 142 eligible HD patients, two seroconverted to overt HCV, and five showed occult HCV. According to the laboratory and ultrasonography (US) data, three patterns of LM were found in 62 (43.7%), non-alcoholic fatty liver disease (NAFLD) in 30 (48.4%), liver fibrosis in 19 (30.6%), and hepatitis in 13 (21%). The mean durations of renal impairment (7.6 ± 5.91), hemodialysis (9 ± 6.1269), and total dialysis sessions (976.26 ± 683.69) were significantly higher in patients with LM compared to others (6.78 ± 4.82, 5.38 ± 3.69, and 699.4 ± 467.1). Alanine aminotransferase (ALT) and Aspartate aminotransferase (AST) levels were elevated in 14 (22.6%) and 13 (21%) of patients with LM. However, the ROC curve revealed ALT and AST cut-off points of 16.5 and 25.5 IU/L to discriminate LM. Conclusion: LM is common among EDRD patients undergoing hemodialysis despite the low levels of ALT and AST. The use of the US and the new lower levels of ALT and AST could improve the screening approach of LM.