Background: Frailty, an age-related trait linked to poor chronic kidney disease (CKD) outcomes, affects 66.3% of Egyptian patients. Two-thirds of elderly CKD patients frequently feel fatigued with high risk of falling. Ultrasound can be used for objective frailty evaluations. Measurement of Bilateral Anterior Thigh Thickness (BATT) using ultrasound is a promising, simple, cheap and non-invasive tool to predict frailty. The current study aims to Evaluate the ultrasound measurements of BATT in screening for Frailty in hemodialysis patients. Methods: The cross-sectional study comprised 120 adult end-stage renal disease (ESRD) patients on regular hemodialysis at Zagazig University from November 2023 to April 2024. The FRAIL scale, clinical exams, frailty phenotypic tests, bilateral anterior thigh muscle thickness by ultrasounds and routine labs were measured. Results: We found gender differences in Frailty (70%) males, (30%) women. Men (45.2%) were more pre-frail than women (13.9%) (p=0.0009), but women (83.3%) were more frail. Females with lower bilateral anterior thigh thickness (36.5±4.7mm) had higher frailty ratings, slower walking speed and poorer hand grip strength compared to men (58.1±10.4mm) (p<0.0001). There was significant positive association between low BATT and Frailty Phenotype score (P=0.0494) (OR=1.096). While there was significant negative association between low BATT and Walking Speed (P=0.0437) (OR=1.0275) and Grip strength (P<0.0001) (OR=0.9795). Conclusion: Bilateral Anterior Thigh Thickness measurements via ultrasound are effective in screening for frailty in hemodialysis patients. Low BATT correlates with higher frailty and worse physical performance, indicating its utility in early detection.