Background: Volume assessment in hemodialysis (HD) patients remains a challenge. We aimed to assess fluid status in children on regular HD by evaluating the changes in chest B-lines and the inferior vena cava collapsibility index (IVCCI). Methods: In this prospective cohort study a total of sixty children on regular hemodialysis underwent lung and IVC ultrasound before and after dialysis. Pre and post dialysis ultrasound changes were assessed, Correlation analysis between these findings was done. Results: A total of 120 ultrasound assessments were performed. There was a significant reduction in the median number of B-lines (4 to 2) and in IVC collapsibility index (from 36.08 to 53.58) before and after dialysis. There is statistically significant correlation between percent change in weight and percent change in B lines r =0.315 (p=0.049). ROC curve showing the best cutoff of B lines after dialysis for detection of pulmonary congestion was ≥7 with area under curve 0.971(sensitivity 87.5%, specificity 70%, positive predictive value 70%, negative predictive value 98%). Conclusion: Chest ultrasound have a significant diagnostic and prognostic value for volume status assessment in Hemodialysis children, that is safe and easily performed especially during this covid19 pandemic.