OBJECTIVES: The current research was conducted to evaluate Congestive Heart Failure (CHF) in dialysis patients; it`s frequency, prognosis, and risk factors among patients attending public healthcare institutes of Quetta city, Pakistan. METHODS:  This is a multicenter cohort study conducted at two public healthcare institutes of Quetta city, Pakistan. Data of 117 patients for one year was screened from the official records and evaluated retrospectively to identify variables of interest. Data was collected through a validated information sheet. SPSS v.20 was used for data analysis and data was described descriptively. RESULTS: All patients had End-Stage Renal Disease (ESRD) and were on regular maintenance hemodialysis therapy. Out of all selected patients, 7.7 % patients had Non-Insulin Dependent Diabetes Mellitus, 4.3% patients had Ischemic Heart Disease, 78.6% had Left Ventricular Hypertrophy and 80.34% had Cardiomyopathy. Forty five patients (38.46%) were confirmed with CHF. Thirty seven (31.6%) of those had systolic dysfunction, 8 (6.8%) had diastolic dysfunction and 4 (3.4%) had both systolic and diastolic dysfunction. In the subjects with systolic dysfunction, 2.6% measured ejection fraction (E.F) of ≤ 20%, 13.7% measured 21-30% and 15.4% measured 3-40%. Additionally, 13 (28.9%) patients developed de novo CHF. Recurrence of CHF was observed in 26 patients (57.7%) whereas among the CHF group, ten patients died during the study period presenting a mortality rate of 24% in CHF group. CONCLUSIONS: The incidence of CHF was relatively high in our study population of ESRD. It was also observed that risk factors of both the disease conditions collaboratively exacerbated each other, resulting in worsening of patients’ condition. Frequent recurrence of the disease, re-hospitalization and enhanced mortality in our study population is evident of adverse prognosis of CHF in ESRD population.