Background: Diabetic kidney disease (DKD) refers to the deterioration of kidney function seen in diabetes mellitus (DM) patients. Patients with end-stage kidney disease (ESKD) frequently experience wide glycemic excursions, which is considered a risk factor for the development of diabetic complications. Blood glucose fluctuations have been documented in hemodialysis (HD) patients with and without diabetes mellitus. The aim of this study was to assess the blood glucose excursion in ESKD patients with and without diabetes mellitus on maintenance HD. Methods: 80 patients were enrolled in this study; 20 non-diabetic ESKD patients on HD and 60 diabetic patients including: 20 patients with type 2 DM, 20 DKD patients and 20 diabetic patients on HD. Blood glucose profile and other laboratory investigations were done. For dialysis patients, random blood glucose levels before, during and after the dialysis session and glucose in dialysate flow were measured. Glucose excursion was expressed as the difference between random blood glucose levels before-during and before-after HD session. Results: Regarding blood glucose profile, fasting, postprandial blood glucose and glycated hemoglobin levels were higher in group IIA (DM without DKD) than group IIC (DKD on HD) (P <0.001). As regard to the dialysis groups, glucose excursion (before-during) was non significantly higher in group IIC than group I(Non-DM on HD), on the other hand there was significant increase in the glucose excursion (before-after) in group IIC when compared with group I (P 0.021). In group IIC, glucose excursion (before-during) and (before-after) were significantly increased in patients treated with insulin than other patients who had not taken antidiabetic medications (P 0.012, 0.016 respectively). In Group I, glucose excursion (before-after) had significant negative correlation with fasting blood glucose (r -0.525, P 0.018). In Group IIC, glucose excursion (before-after) and (before-during) had significant positive correlation with 2 hours postprandial blood glucose (r 0.573, P 0.008) (r 0.506, P 0.023), respectively. Conclusion: Blood glucose excursion occurs more in diabetic hemodialysis patients than non-diabetic patients on hemodialysis, and in patients on insulin therapy more than non-insulin regimens. Hemodialysis decreases blood glucose proved by the presence of glucose in the dialysate outflow. Blood glucose profile is linked to glucose excursion, inferring that good glycemic control is important to decrease blood glucose fluctuations.