Introduction: Cardiovascular disease is the most common cause of morbidity and premature mortality in patients on chronic haemodialysis. There is limited data on cardiac abnormalities among these patients in sub-Saharan Africa including Uganda. We determined the prevalence and patterns of echocardiographic abnormalities among patients with end stage renal disease (ESRD) on haemodialysis at Mulago National Referral Hospital, Kampala, Uganda Methods: We recruited all eligible patients with ESRD over a period of five months. Data on demographic characteristics including age, sex, occupation, level of education, address and factors associated with echocardiographic abnormalities such as hypertension, diabetes mellitus, fluid overload were collected using a standardized questionnaire. Cardiac evaluation was done using a transthoracic echocardiography performed for all study participants and findings entered into a data sheet. Data was then entered into Epidata and exported into STATA, bivariate analysis was done for all factors and then multivariate analysis using logistic regression to determine independent factors associated with echocardiographic abnormalities. Results: Fifty-three (66.2%) of the 80 patients were male and mean age was 49 years (SD±16). Twenty-eight (35%) had to travel a distance of >50 km to access haemodialysis. Seventy-four patients (92.5%) had at least one cardiac echo abnormality and twenty-four (30%) had at least three abnormalities. Left ventricular hypertrophy (67.5%, 54/80) and diastolic dysfunction (63.8%, 51/80) were the most common echo abnormality patterns. Patients with LVH were more likely to be male (p= 0.022). Patients with diastolic dysfunction were more likely to have been on haemodialyis for a period of at least six months (p= 0.018). Conclusions: In this study, majority of patients with ESRD on haemodialysis at Mulago National Referral Hospital (MNRH) had at least one echocardiographic abnormality with the most common being LVH and diastolic dysfunction. We recommend that routine echocardiography may be warranted as part of routine care of all patients on hemodialysis at MNRH.