Background: Left ventricular hypertrophy (LVH) represents an important determinant of increased cardiovascular mortality (CV) in end stage renal disease (ESRD) patients. The role of inflammatory markers in pathogenesis of LVH in children with ESRD is not fully described. The aim of this study is to evaluate the relation of some inflammatory markers (as high-sensitive C-reactive protein (hs CRP) and interleukin-18 (IL-18) with LVH in children with ESRD on regular hemodialysis (HD). Methods: This is a cross-sectional study performed on 50 children on regular HD. Demographic data were recorded. Echocardiography was performed at baseline to determine those with LVH. Biochemical parameters: hemoglobin, hs-CRP, IL-18, phosphorus, calcium, serum albumin and lipid profile were evaluated and correlated with LVH. Data were analyzed by using student’s t test, and logistic regression to determine the relationship between LVH and other variables. Results: LVH was present in 33 (66%) participants. Mean left ventricular mass index (LVMI) was 56.88±22.23 gm /m2.7. Concentric remodeling, concentric hypertrophy and eccentric hypertrophy were present in 4, 22 and 44% of the participants. In univariate analysis: children with LVH had significantly lower levels of hemoglobin and serum albumin but higher levels of hs- CRP, and IL-18 compared to those without LVH. On multivariate analysis: only hs-CRP, and IL-18 were significantly associated with LVH. Conclusions: This study shows that elevated hs-CRP and IL-18 are independent determinants of LVH in HD children. Understanding the role of inflammatory molecules in the pathogenesis of LVH in ESRD is important for prediction of high risk group and implementation of targeted anti-inflammatory therapies.