Background: Renal failure refers to a condition where the kidneys lose their normalfunctionality. Patients with end stage renal disease (ESRD) have to undergohemodialysis (HD), With impaired renal function, a decreased glomerularfiltration rate (GFR), and the accumulation and retention of various products ofrenal failure, the oral cavity may show a variety of changes as the body progressesthrough an azotemic to a uremic state. The general dentist should be able torecognize these oral symptoms as part of the patient’s systemic disease and not asan isolated occurrence.Aims of the study: To evaluate the biochemical properties of the saliva andAssessment of oral manifestations in patients with chronic renal failureundergoing hemodialysis.Patients and methods: Spectrophotometer was used for measuring serum andsalivary calcium, phosphorous, urea and creatinine in thirty three hemodialysispatients and twenty two control healthy subjects . Salivary PH, Gingival indexand salivary buffering capacity was also recorded.Results and discussion: All serum and salivary biomarkers (calcium, phosphorous,urea and creatinine) were significantly changed in hemodialysis patients (calciumdecreased while the others increased).Also salivary PH and buffering capacitywere significantly increased in hemodialysis patients. Gingival index alsoincreased, and the oral manifestations that was recorded include: dry mouth(n=21), uremic odor (n=20) , bad taste (n=17) , burning sensation (n=14) , coatedtongue (n=10) ,pale mucosa ( n=5) petechia (n=3), fissured tongue (n=3).Conclusions: there was differences in salivary parameters between hemodialysispatients and control group and the salivary variables was correlated too serumvariables , many oral manifestations found to be in hemodialysis patients.