Introduction. Patients undergoing hemodialysis frequently exhibit some degree of sensorineural hearing loss (SNHL). The underlying mechanisms are not fully understood, and it remains uncertain whether this impairment results from the hemodialysis procedure itself or from chronic renal failure (CRF). Methods. A total of 61 patients (122 ears) were examined: 39 subjects undergoing hemodialysis treatment for more than one year, 12 subjects initiating hemodialysis, and 10 healthy controls. Hearing assessment was performed using pure tone audiometry (PTA) and distortion product otoacoustic emissions (DPOAE). DPOAE was applied only in participants with normal middle ear conditions and hearing thresholds better than 30 dB HL, using a 65/55 dB SPL (L1/L2) setting. Additional clinical parameters, including blood pressure, body weight, and blood chemistry, were also recorded.