Background: Restless leg syndrome (RLS) is one of the annoying conditions that negatively impacts sleeping and quality of life in hemodialysis (HD) patients. Objectives: This study aimed to detect the effectiveness of active versus sham acupuncture-like transcutaneous electrical nerve stimulation (Acu-TENS) on RLS in HD patients. Patients and methods: Computerized block list was utilized to randomly allocate 60 hemodialysis (HD) patients into two groups: Study and control groups. Group A (n=30) received electrical stimulation over acupuncture points through the TENS unit on the left and right legs typically for 30 minutes during the dialysis session, 3 times a week for 3 months. Group B (n= 30) received sham Acu-TENS to non-true acupoint (2 cm away from true acupoints that were selected for the study group) bilaterally at the same time for 30 minutes three times weekly for 12 weeks. Results: A significant improvements ofInternational Restless Legs Syndrome Study Group Rating Scale (IRLSSG) and fatigue and quality of sleep were documented within group A but outcome of group B did not show the same improvements. After treatment, when the two groups were compared, group A's results significantly improved. Conclusion: It was concluded that the application of Acu-TENS significantly improved symptoms of RLS, quality of sleep and fatigue, in HD patients with RLS.