Background: The hallmark of gout is hyperuricemia. This substance is linked to the pathophysiology of cardiovascular disease, the primary cause of death among dialysis patients. Hyperuricemia is associated with cardiovascular conditions including hypertension, diabetes, and insulin resistance. High SUA levels prevent mortality from all causes. Relationships between SUA and all-cause mortality were J-shaped, according to smaller studies. In keeping with SUA's role in protein metabolism, new study indicates that it may be employed as a nutritional status indicator in hemodialysis patients. Rather than a high SUA, a superior nutritional state may explain survival connections. In HD patients, LVH with diverse etiologies is predictive of CV mortality and morbidity. Aim: to study the association of pre and post – dialysis uric acid difference to left ventricular structural and functional disorders in maintenance hemodialysis patients. Subject and Methods: This study was carried out on ESRD Patients in internal medicine department of Benha University in the hemodialysis unit, where 100 patients were selected. Results: There were high statistically significant differences between the studied patients systolic and diastolic blood pressure before and after hemodialysis. There were high statistically significant differences between the studied patient’s serum level of uric acid, creatinine and urea before and after hemodialysis. Conclusion: This study showed that there was significant correlation between uric acid and LV ejection fraction as well as LV parameters. In regression analysis we found that serum uric acid was a significant predictor of LV ejection fraction.