Background: Chronic renal failure is defined as kidney damage, or a reduction in the glomerular filtration rate, for three or more months. Few studies were performed regarding the oral health status of chronic renal failure patients in Sudan.Objective: Study aims to investigate the pattern of orofacial manifestations in patients with chronic renal failure in Sudan and how the disease affecting their oral health. Methods: The present study is a hospital based study conducted at Dr. Salma Center for Treatment of Kidney diseases, University of Khartoum, Sudan and Department of Nephrology at Ahmed Gasim Hospital for Heart Surgery and Kidney Diseases –khartoum Bahri, Sudan, between January to June 2019. Two hundred and twenty six patients participated in the study. The frequency and pattern of orofacial manifestations among those patient in addition to presence of additional systemic diseases ,duration of dialysis and mean levels of urea ,creatinine and hemoglobin were all investigated. Results: Oral lesions were present in 103 out of 226 (45.6%) patients with chronic renal failure .Xerostomia was the most manifestation encountered [145 (64.2%)], followed by orofacial abcess , ulcers and candidiasis . Hypertention was the commonest systemic disease encountered .No significant difference was found regarding the orofacial manifestations with duration of dialysis ,urea ,hemoglobin and creatinine mean levels.Conclusions: Prevalence of orofacial manifestations was significantly high among CRF patients .Xerostomia was the main complaint recognized. The findings of the present study emphasize the importance of dental practitioners in monitoring the oral health of patients with chronic renal faliure, and the need for regular clinical examinations to ensure early diagnosis and management of patients.