Aim: The aim of the present study is to evaluate the association between IVC Diameter and LVESD with all-cause mortality in patients undergoing hemodialysis. Methods: We conducted a hospital based single-center observational study. Patients above 18 years of age who attended the Nephrology and Cardiology departments and underwent chronic Hemodialysis treatment via functional AVA (arteriovenous access) at the HD unit of the tertiary care center for a period of one year were enrolled in this study. A total of 200 adult chronic HD patients who had functional AVA and those who underwent echocardiography examination were only enrolled in this study. Results: The group of patients with high ivc diameter (IVCD) had a mean age of 64.5 ± 12.2 years, which was lower than the mean age of 66.0 ± 13.6 years for the group of patients with low IVCD. The majority of patients with high IVCD were male (63% male vs. 37% female), while among patients with low IVCD, 45% were male and 55% were female, respectively. There were no notable disparities in the use of antihypertensive drugs, oral antidiabetic medications, and anticoagulants between the two groups. There was no notable disparity in the aortic root and relative wall thickness between the two groups. Patients exhibiting high ivc diameter (IVCD) demonstrated significantly larger measurements in various cardiac parameters compared to those with low IVCD. These parameters include the interventricular septum, left atrium diameter, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular posterior wall, left ventricular mass, and left ventricular mass index. The statistical analysis showed that all of these differences were highly significant (p < 0.001). High ivc diameter (IVCD) individuals had significantly higher rates of all-cause death, cardiovascular mortality, and major adverse cardiovascular events (MACE) compared to low IVCD patients. Conclusion: Increased risk of all-cause mortality, MACE-events, and poor survival in chronic HD patients is linked to dilated IVCD (≥1.5 cm). High IVCD and LVESD patients also have higher all-cause mortality and MACE. IVCD measures may reduce chronic HD mortality risk through fluid control with patient education or dry weight modifications.