Background: Heart failure is the cumulative and progressive result of conditions that cause structural defects and functional abnormalities in the heart. It is affects at least 26 million people worldwide and is increasing in prevalence especially among hemodialysis patients with severe renal failure. Objective: To assess the incidence and predictors of congestive heart failure among hemodialysis patients at Felege Hiote Referral Hospital, Northwest Ethiopia. Methods: This institutionally based retrospective cohort study was undertaken among 205 hemodialysis patients of Felege Hiote Referral Hospital from January 1, 2016 to February 29, 2020. All eligible hemodialysis patients who fulfilled the inclusion criteria were included in the study. Data were entered using Epi-data Version 4.1 and analyzed using STATA Version 14. The survival time of hemodialysis patients was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables was compared using the log rank test. Both bivariable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of congestive heart failure among hemodialysis patients. Results: Among a cohort of 205 hemodialysis patients at Felege Hiote Referral Hospital, 12 (5.9%) developed congestive heart failure during the follow-up time. The overall congestive heart failure incidence rate was 2.9 per 100 person-years (PY) with 95% CI. The total time allotted to follow up the study participants was 4968 PY. Using multivariable Cox-regression analysis, we found that male sex, rural residence, no formal education, low body mass index (<18.5), presence of comorbidity, and anemia during dialysis initiation significantly increased the risk of heart failure. Conclusion: In this study, we found a high rate of congestive heart failure among hemodialysis patients. Factors significantly linked with increased risk of heart failure included male sex, rural residence, no education, low body mass index (<18.5), presence of comorbidity, and anemia during dialysis initiation. Early screening and treatment for heart failure are highly recommended at hemodialysis follow-up for patients with the above risk factors.