Objective: We retrospectively investigated ESRD patients on HD through a medical record review. We divided patients into those experience who experienced any admission due to acute decompensated HF (ADHF) and those who did not. We compared medical histories, electrocardiograms, and echocardiographic and laboratory data between the groups. Methods: Of the 188 ESRD patients on HD, 87 were excluded, and 101 were enrolled (mean age: 63.7 years, 52.1% male). Thirty patients (29.7%) were admitted due to ADHF. These patients exhibited similar left ventricular ejection fraction (LVEF), left ventricular (LV) mass index, and E/E’ compared to the non-ADHF group. However, the ADHF group demonstrated significantly higher tricuspid regurgitation (TR) jet velocity (2.9 ± 0.6 vs. 2.5 ± 0.4 m/s, respectively; p=0.004) than the non-ADHF group. The ADHF group also showed a higher N-terminal pro B natriuretic peptide level (2175.7 ± 14,404.8 vs. 11,895.7 ± 13,441.4 pg/dL, respectively) than the non-ADHF group. Multivariate logistic regression analysis demonstrated that TR jet velocity (odds ratio: 8.356, 95% confidence interval: 1.806–38.658; p=0.007) was an independent predictor of ADHF after adjusting for age and sex, while LVEF and E/E’ were not. Per receiver operating characteristic curve analysis, TR jet velocity > 2.8 m/s was associated with ADHF with 47.7% sensitivity and 76.4% specificity (area under the curve: 0.656). Results: Our data showed that increased TR jet velocity was an independent predictor of ADHF events in ESRD patients on HD, but LVEF and E/E’ were not.   Conclusions: Objective: Many patients with end-stage renal disease (ESRD) on hemodialysis (HD) experience left ventricular hypertrophy and reduced vascular compliance and are likely to develop heart failure (HF). We aimed to determine the hemodynamic factors associated with acute decompensated events among ESRD patients undergoing HD. Methods: We retrospectively investigated ESRD patients on HD through a medical record review. We divided patients into those experience who experienced any admission due to acute decompensated HF (ADHF) and those who did not. We compared medical histories, electrocardiograms, and echocardiographic and laboratory data between the groups. Results: Of the 188 ESRD patients on HD, 87 were excluded, and 101 were enrolled (mean age: 63.7 years, 52.1% male). Thirty patients (29.7%) were admitted due to ADHF. These patients exhibited similar left ventricular ejection fraction (LVEF), left ventricular (LV) mass index, and E/E’ compared to the non-ADHF group. However, the ADHF group demonstrated significantly higher tricuspid regurgitation (TR) jet velocity (2.9 ± 0.6 vs. 2.5 ± 0.4 m/s, respectively; p=0.004) than the non-ADHF group. The ADHF group also showed a higher N-terminal pro B natriuretic peptide level (2175.7 ± 14,404.8 vs. 11,895.7 ± 13,441.4 pg/dL, respectively) than the non-ADHF group. Multivariate logistic regression analysis demonstrated that TR jet velocity (odds ratio: 8.356, 95% confidence interval: 1.806–38.658; p=0.007) was an independent predictor of ADHF after adjusting for age and sex, while LVEF and E/E’ were not. Per receiver operating characteristic curve analysis, TR jet velocity > 2.8 m/s was associated with ADHF with 47.7% sensitivity and 76.4% specificity (area under the curve: 0.656). Conclusions: Our data showed that increased TR jet velocity was an independent predictor of ADHF events in ESRD patients on HD, but LVEF and E/E’ were not.