Aim: The aim of this study was to evaluate the prevalence, types, and associated factors of skin manifestations in patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis. Material and Methods: This observational, cross-sectional study was conducted on 100 CKD patients undergoing maintenance hemodialysis at a tertiary care hospital. Patients aged ≥18 years, with CKD Stage 5 undergoing hemodialysis for at least six months, were included. Comprehensive dermatological examinations were conducted, and skin manifestations were classified. Laboratory parameters, including serum urea, creatinine, calcium, phosphorus, parathyroid hormone (PTH), hemoglobin, and albumin levels, were analyzed. Data were statistically evaluated using SPSS version 16.0 to determine prevalence and associations. Results: Skin manifestations were highly prevalent, with xerosis (78%), pruritus (64%), and hyperpigmentation (52%) being the most common. Significant associations were observed between xerosis and low albumin (p < 0.01), pruritus and elevated phosphorus (p < 0.05), and nail changes with elevated PTH levels (p < 0.01). Laboratory analysis revealed elevated phosphorus (mean: 6.1 ± 1.4 mg/dL) and PTH levels (mean: 450 ± 200 pg/mL), as well as low hemoglobin (mean: 9.2 ± 1.8 g/dL) and albumin levels (mean: 3.4 ± 0.5 g/dL). Logistic regression identified hypoalbuminemia, elevated phosphorus, and longer dialysis duration as key predictors of skin manifestations. Conclusion: This study highlights the significant burden of skin manifestations in CKD patients undergoing dialysis, emphasizing their association with biochemical imbalances and poor nutritional status. Early recognition and targeted management of these conditions are essential for improving patient outcomes and quality of life.