Despite rapid improvements in dialysis technology, the mortality rate in ESRD patients treated with dialysis is very high, The main cause is cardiovascular disease (CVD).TNF alpha plays an important role in the pathology CVD. The present work aimed to evaluate TNF alpha gene expression in patients with ESRD on regular hemodialysis as an expression of CVD risk even on a subclinical level. A total number of 51 Egyptian patients with ESRD on regular hemodialysis and 20 healthy subjects as a control group were recruited from Kasr Al Aini dialysis unit, Faculty of Medicine, Cairo University. Both groups had comparable age and sex. Comparison between group 1(cases of ESRD) and group 2(normal controls) showed that triglycerides(TGS) level, CRP positivity, relative quantification (RQ) of TNF alpha gene expression and IMT were significantly higher among cases than controls but HDL level was significantly lower among cases when compared with that among controls. We conclude from results in our study that our patients with ESRD are having increased risk for CVD as denoted by a heightened state of inflammation expressed by increased gene expression of TNF alpha and CRP titer together with increased atherosclerosis as expressed by increased cIMT. Both inflammation and atherosclerosis are important denominators of uremic arteriopathy.