To assess the prevalence and determinants of cardiac dysfunction in hemodialysis patients, M-mode and Doppler echocardiography were performed in 130 patients (79 male and 51 female; mean age, 59.8 years; mean time on chronic dialysis, 9.6 years; diabetes 31 patients). Left ventricular (LV) hypertrophy was observed in 102 patients (78%) and the associated risk factor was systolic hypertension. LV cavity size rarely enlarged (3.8%) without a predictor. LV systolic dysfunction was found in 13 patients (10%) and interdialytic weight gain and ischemic heart disease were the determinants. LV diastolic function was abnormal in 43% and was associated with older age. These results suggest that LV abnormalities, which are common in patients on chronic hemodialysis, are associated with hypertension, interdialytic weight gain, ischemic heart disease and older age. Therefore, good blood pressure control and adequate nutrition management, including water and salt restriction, are likely important in hemodialysis patients due to a high prevalence of cardiac death.