Mortality due to cardiovascular complications (CVC) in patients with end stage renal disease (ESRD) is 20 fold higher than in general population. Adiponectin (ADPN) hormone from adipose tissues accumulation in serum is attributed to reduced renal clearance. The aim of this study was to investigate the possible role of ADPN as a predictor of CVC in adult patients with ESRD on hemodialysis (HD), and to evaluate the relationship between its levels and other CVC risk factors. 30 ESRD patients on regular HD with evidence of CVC (group 1), 30 ESRD patients on regular HD without evidence of CVC (group 2) and 20 age and sex matched healthy subjects (group 3) were enrolled into the study. All participants were subjected to clinical examination and laboratory investigations. Serum C-reactive protein (CRP) and ADPN concentrations were measured by ELISA. Echocardiography was performed for cardiac abnormalities estimation. The most common CVC in patients with ESRD was angina (53.33%) followed by myocardial infarction (33.33%). Patients with CVC had significant increased frequencies of risk factors (body mass index, total cholesterol, triglyceride and low density lipoprotein, and CRP in comparison with patients without CVC (P< 0.05). Additionally, both patient groups had a significant higher serum ADP levels in comparison with controls (P<0.001), with ADPN concentrations being higher in patients with CVC than those without CVC (P<0.001). Echocardiography showed significant differences between group 1 and group 2 regarding ejection fraction (EF %) and wall motion (P <0.002 and <0.001 respectively). Correlation studies in patients with CVC revealed that there were significant negative correlations between ADPN levels and duration of dialysis (r= - 0.346, P = 0.049), low density lipoprotein (r= - 0.542, P= 0.002), CRP (r= - 0.605, P< 0.001) and EF% (r= - 0.337, P= 0.049). ADPN sensitivity and specificity were 93.3%, and 83.3%, respectively, with 84.8% positive predictive value and 92.6% negative predictive value compared to 56.7% sensitivity, 90% specificity, 82.4% positive predictive value and 62.8% negative predictive value for EF%. Low serum ADPN level could be used as a predictive marker of CVC in ESRD and progression of CKD and may help in planning preventive strategies for ischemic heart disease.