Background and objectives: Adrenomedullin (AM), a peptide involved in cardiovascular homeostasis, is believed to protect both cardiac and renal functions by increasing local blood flows, attenuating the progression of vascular damage and remodelling and by reducing glomerular injury and might be involved in hemodialysis physiopathology. This work was performed to investigate whether an increase in circulating AM might be related to hemodialysis cardiac function, volume overload, or inflammation and whether mortality and cardiovascular morbidity can be predicted by mAM.Methods: In supine position, heart rate and systemic blood pressure were measured together with plasma adrenomedullin levels and C-reactive protein (CRP) before hemodialysis in sixty patients as well as in 20 healthy subjects matched for age, gender, body mass index (BMI) served as control group. Systolic and diastolic cardiac functions were assessed, using Doppler echocardiography.Results: Plasma adrenomedullin levels were significantly higher in hemodialysis group compared to control. Subjects were similar concerning age, BMI, heart rate and blood pressure. Cardiac systolic and diastolic functions were impaired in hemodialysis patients compared to controls. In a simple correlation analysis, plasma adrenomedullin levels were negatively correlated with systolic, diastolic blood pressure, S/D ratio, deceleration time, and left ventricular ejection fraction. However, it was positively correlated with plasma CRP level, removal fluid volume by ultrafiltration (delta body weight), LVEDD, LVWT, DcT, mitral S/D ratio, Pva and inferior vena cava diameter. During a 1-year follow-up period, 12 patients died and 7 had additional cardiovascular events. Patients with high plasma mAM levels had higher mortality and morbidity than those with low plasma mAM levels.Conclusion: Hemodialysis patients present with increased adrenomedullin levels that correlate with cardiac systolic, diastolic dysfunction, systemic inflammation, and volume overload. These levels may provide a possible index of these conditions in haemodialysis patients with concomitant cardiovascular disease. Other studies will therefore be useful to determine whether adrenomedullin infusion might improve hemodialysis cardiac dysfunction, as it has been shown to be beneficial after myocardial infraction