Background: Ghrelin metabolism is affected by variations in residual renal function and one of the most important factors affected on serum ghrelin concentrations was found to be Helicobacter pylori (H. pylori) infection in gastric mucosa. Aim of the study: The aim was to assess the effect of H. pylori infection on serum Ghrelin in hemodialysis cases .Methods: This prospective study including 90 participants, 70 CKD patients who received hemodialysis three times per week and 20 healthy volunteers. Group (1):35 CKD patients on hemodialysis with a positive H. Pylori infection. Group (2): 35 CKD Patients on hemodialysis with negative H. Pylori Infection. Group (3):20 apparently healthy age and gender matched volunteers as a control group. All eligible cases were evaluated for CBC, renal function tests, H. pylori stool Ag test and serum Acylated Ghrelin using ELISA technique .Results: Ghrelin levels were significant difference among the three groups (P<0.001). Ghrelin level was significantly decreased in group 1 than group 2 and 3(P<0.001) and insignificantly between group 2 and group 3. Conclusion: In patients with a positive H. Pylori infection, Ghrelin levels were much lower than those of patients with a negative H. Pylori infection and healthy persons.