Objective: A procedural database for tunneled cuffed hemodialysis catheter placements between January 2018 and March 2021 were reviewed retrospectively. Catheter tip positions were determined as those located within the right mid atrium or else by anatomical landmarks on the chest radiography. Patient demographic and dialysis related parameters including URR were compared according to catheter tip locations. Methods: Database revealed 1,209 catheter insertions in 1,080 patients (648 male, mean 60 age). Pre and post blood urea and dialysis parameters were available in 977 cases. Of these, 597 catheters were placed in the right mid atrium (RA group), while 380 catheters were placed elsewhere: superior vena cava, cavoatrial junction, or inferior vena cava (Malposed group). Patient demographic characteristics including age, sex, BMI, and presence of diabetes as well as dialysis parameters including dialysis time, blood flow rate, ultrafiltration rate, blood pressure at the start of dialysis were comparable between the two groups. Among these parameters, urea reduction rates were significantly lower in the catheter malposed group as compared to those located in the mid-RA (9.56 ± 25.6% vs. 38 ± 15.5%, respectively, P < 0.05). Catheter tips placed in the mid RA were associated with greater achievement of dialysis adequacy as determined by URR ≥ 60%. (Odd ratio 8.219, 95% Confidence Interval 2.939-22.984). Results: Catheter tips placed in the mid RA are associated with greater achievement of dialysis adequacy. Conclusions: Objective: Hemodialysis catheter tip malposition is associated with an increased risk of catheter dysfunction. It is inferred that catheter placed other than the mid of right atrium may be associated with inadequate dialysis because of limited blood flow rate it can deliver. This study aimed to establish an association between catheter tip positions and dialysis adequacy as determined by urea reduction rate (URR) post dialysis. Methods: A procedural database for tunneled cuffed hemodialysis catheter placements between January 2018 and March 2021 were reviewed retrospectively. Catheter tip positions were determined as those located within the right mid atrium or else by anatomical landmarks on the chest radiography. Patient demographic and dialysis related parameters including URR were compared according to catheter tip locations. Results: Database revealed 1,209 catheter insertions in 1,080 patients (648 male, mean 60 age). Pre and post blood urea and dialysis parameters were available in 977 cases. Of these, 597 catheters were placed in the right mid atrium (RA group), while 380 catheters were placed elsewhere: superior vena cava, cavoatrial junction, or inferior vena cava (Malposed group). Patient demographic characteristics including age, sex, BMI, and presence of diabetes as well as dialysis parameters including dialysis time, blood flow rate, ultrafiltration rate, blood pressure at the start of dialysis were comparable between the two groups. Among these parameters, urea reduction rates were significantly lower in the catheter malposed group as compared to those located in the mid-RA (9.56 ± 25.6% vs. 38 ± 15.5%, respectively, P < 0.05). Catheter tips placed in the mid RA were associated with greater achievement of dialysis adequacy as determined by URR ≥ 60%. (Odd ratio 8.219, 95% Confidence Interval 2.939-22.984). Conclusions: Catheter tips placed in the mid RA are associated with greater achievement of dialysis adequacy.