Background: Worldwide coronavirus disease 2019 (COVID-19) is caused by a coronavirus, one of the newly recognized and quickly spreading primary causes of pneumonia and severe acute respiratory syndrome (SARS-CoV-2). Patients with ESRD are most susceptible to morbidity and death linked to COVID-19. Objective: The purpose of this study was to evaluate the importance of the NLR in ESRD patients as an inflammatory marker of COVID-19. Patients and Methods: Eighty-four ESRD patients on maintenance hemodialysis at Ain Shams University Hospitals from February 2021 to the end of July 2021 participated in this prospective cohort research. Results: Our results showed a greater level of NLR in the COVID-19 group, with a cut-off value of 5.26. Among all hematological measures, NLR had the highest specificity (95.24%) and sensitivity (76.19%) for COVID-19. Furthermore, there is a substantial positive connection between NLR and COVID-19 mortality. In the COVID group, NLR alone had a higher correlation with CRP than lymphocyte and neutrophil numbers. Our findings revealed that COVID-19 ESRD patients had substantially higher D dimer, LDH, CRP, and ferritin levels than non-COVID-19 ESRD patients. The COVID group in our study showed severe hypoalbuminemia, anemia, and a lower urea reduction rate (URR). Conclusion: In ESRD patients, NLR, neutrophilia, and lymphopenia are thought to be predictive of COVID-19 illness. On the other hand, NLR has the highest specificity and sensitivity. In ESRD patients with COVID-19 illness, greater NLR levels were linked to increased death rates. Our findings showed that the COVID-19 patients receiving continuous hemodialysis fared better when anticoagulation and antiviral medication were used.