Background: Hemoglobin variability (HB), defined as hemoglobin value varying between low, normal and high levels, is a common condition among hemodialysis (HD) patients. Atherosclerotic lesions are highly prevalent in patients with chronic kidney disease (CKD). Carotid artery Intima-Media Thickness (CIMT) is noninvasive ultrasound test recommended to screen for heart disease. This work aimed to evaluate the relation between Hemoglobin variability and CIMT among the studied patients. Methods: A cross-sectional study was conducted on 70 patients on (HD) attending HD units in Internal Medicine Department in Zagazig University Hospitals and Al- Ahrar teaching hospital during the period from February 2018 to February 2019. Patients underwent history taking, clinical examination, and laboratory investigations. Efficiency of hemodialysis was calculated. CIMT is measured in B-mode ultrasound image using Doppler on carotid arteries. Results: A significant positive correlation is detected between hemoglobin change and both CIMT and total cholesterol. However, there is significant negative correlation between hemoglobin change and hematocrit level. A significant negative correlation is present between CIMT and hematocrit value, total protein and CRP. A significant positive correlation is present between CIMT and serum albumin, serum creatinine, BUN and total cholesterol. The best cutoff of hemoglobin variability in prediction of abnormal CIMT is ≥ 3.45with sensitivity 86.7%, specificity 90.9%, positive predictive value 72.2% , negative predictive value 96.1% with accuracy 90% (p<0.001). Conclusion: Hemoglobin variability was associated with high CIMT in chronic HD patients. Hemoglobin variability ≥ 3.45, higher BUN, total cholesterol and CRP increase risk of abnormal CIMT.