Introduction: End-stage renal disease (ESRD) is becoming a global health problem for everyone and it has two main leading causes Hypertension and Diabetes Mellitus. The main treatments for ESRD are hemodialysis, renal transplant and conservative treatment. There were lot many factors that directly affect the Quality of Life (QOL) of ESRD patients and non-adherence to the regimen as missed hemodialysis sessions was a sign of poor compliance. The present study aimed to assess the adherence to hemodialysis & factors affecting QOL among patients with ESRD Method: A quantitative research approach and descriptive research design were used to conduct with 116 ESRD patients, purposive sampling technique was used and the study data was collected by interview method by administering three tools i.e. Sociodemographic data, a structured questionnaire on adherence to hemodialysis and standardized WHOQOL-BREF for assessing QOL.