Abstract Left ventricular hypertrophy (LVH) is common and is an independent cardiac risk factor in dialysis patients. The aim of this study was to assess hemodynamic determinants of LVH and, more particularly, the relationship between left ventricular mass, myocardial contractility, and load conditions. Eighty dialysis patients aged 51 ± 15 years were prospectively studied by echocardiography. LVH was detected in 62 patients (78%). Left ventricular mass was significantly correlated to both end-diastolic volume ( r = 0.54; P < 0.001) and end-systolic stress/end-systolic volume, an index of contractility ( r = −0.66; P < 0.001), but not to systolic blood pressure or end-systolic stress, both indexes of afterload. Thus, in dialysis patients, the degree of LVH is significantly correlated with the severity of both left ventricular dilatation and contractile myocardial failure, but not with left ventricular afterload.