Background: Increasing workload can aggravate stress and cause burnout and exhaustion. The study aimed to assess knowledge, performance and stress level among nurses in hemodialysis unit. Methodology:  A descriptive study was carried out to assess Knowledge, Performance and Stress.  Level among Nurses in Hemodialysis Unit .The study was conducted in general hospital in Khartoum state. A Convenience sample was used to include 50 nurses. Data Collection methods: A self-administered study questionnaire was used to collect the data about social demographic, knowledge about hemodialysis process and level of stress.  The second tool was observational check list to measure performance of nurses in hemodialysis unit. The result: A significant portion of nurses, 42%, demonstrated a satisfactory level of knowledge about the Hemodialysis process. Regarding performance 58% of the nurses achieved a satisfactory rating. In relation to stress level 60% of the studies nurses suffer from severe level of stress. There was significant correlation between stress score with total score of knowledge, performance and years of experience. Conclusion: The study revealed that more than half had unsatisfactory knowledge, but 58% demonstrated satisfactory performance. A concerning finding is that around two-thirds reported severe stress, indicating a significant workplace challenge. Recommendations: Develop and implement targeted stress management programs tailored to the specific needs of nurses.