Objective: Patients with end-stage renal disease (ESRD) receiving maintenance hemodialysis are susceptible to numerous intradialytic complications, which critically affect both morbidity and mortality rates. Accurate identification of the prevalence and determinants of these complications is crucial for enhancing patient management and healthcare outcomes. Methods: In this observational cohort study, 104 patients undergoing maintenance hemodialysis at a tertiary healthcare facility were evaluated. Data collection focused on demographic details, existing comorbid conditions, specific dialysis-related parameters, and types of vascular access utilized. Statistical analysis, performed using SPSS, aimed to identify significant correlations between patient attributes and the occurrence of intradialytic complications. Results: The analysis encompassed 104 hemodialysis recipients, identifying a significant occurrence of hypotensive episodes in 59.0% of patients, accompanied by symptoms such as fatigue and muscle cramps. The predominant method of vascular access was arteriovenous fistula, used by 87.0% of patients. Adherence to the Kidney Disease Outcomes Quality Initiative (KDOQI) and the European Best Practice Guidelines (EBPG) was notably low, recorded at 11.1% and 6.8% respectively, highlighting a critical need for enhanced therapeutic and management strategies to reduce the incidence of intradialytic complications. Conclusion: The prevalence of intradialytic complications remains high among ESRD patients undergoing maintenance hemodialysis, with cardiovascular comorbidities playing a substantial role in increasing risk. Optimal management strategies, including meticulous fluid and medication regulation, are essential to reduce these complications and thus improve overall patient health outcomes.