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Dialysis is initiated in a patient with End stage renal disease. The recent guidelines suggest the initiation of dialysis when symptoms and signs of kidney failure are present and not merely a decrease in GFR. The most common complication postdialysis is the occurrence of hypotension. However many dialysis patients are found to be hypertensive. In this article, we mention the cause and pathophysiology of hypertension in dialysis patients and its management.