Background: End-stage kidney disease (ESKD) may predispose the patients to greater a burden cerebral atrophy and white matter complexity. We evaluate the clinical and laboratory effects of different exercise types on the physical, mental performance and the efficiency of the dialysis process in hemodialysis patients. Methods: Interventional cohort study was carried out on 62 patients with (ESKD) maintained on hemodialysis. divided into group I; 20 treated with low intensity aerobic exercise, Group II; 20 treated with low intensity anaerobic exercise and Group III: 22 treated with combined exercise. intradialytic and dialysis day of for 40-50 min during the first hour of dialysis session and the exercise program were done by our rehabilitation team. All were evaluated for physical performance & mental functions, before and after completion of the program. Results: Combined exercise have a highly significant improving effect on modified mini-mental state exam (cognition)(P=0.0001) and a significant improvement on Addenbrooke's Cognitive Examination Revised (P<0.05) and executive function, (P<0.02), Beck's Depression Inventory-II (depressive symptoms) (P<0.0004), physical performance (P<0.0001), and dialysis efficiency (P=0.016). Anaerobic exercise has a significantly improving effect on dialysis efficiency (P<0.0002) while aerobic exercise has significantly improved effect on depressive symptoms (P<0.0001). Conclusions: Combined exercise significantly improved cognition and executive functions and physical performance. Dialysis efficacy is highly significant in the group under anaerobic exercise.