Objectives: To evaluate electrocardiographic changes related to potassium level and it's severity in end stage renal disease patients. Methods: This is a prospective cross sectional study of emergency department patients with end stage renal disease on replacement therapy with hyperkalemia and ECG recorded at time of hyperkalemia, inclusion criteria were(potassium level >5.5 and age>18 years. We clssified hyperkalemia into mild(5.5-6mmol\L), moderate(6-7mmol\L), and asevere (>7mmol\L), for analyzing the relationship between potassium level and ECG changes. Results: A total of 125 cases were collected, of those 25 were excluded because they didn't meet the inclusion criteria, the sample consist of 100 patient {men 53% _women47%}Median age of patients was 53.5 years+/- 17.5. The number of normal ECG were 33, with 67abnormal ECG mainly showing hyperacute T wave(55) patients and prolonged PR interval(35) patients, QRS prolongation (16) patients, sine wave(5) patients, asystole(2) patients and atrial fibrillation(AF) in (6) patients. Conclusion: The ECG is a good tool of early hyperkalemia detection, correlating significantly to it's severity. Patients with end stage renal disease present electrocardiographic alterations similar to patients with hyperkalemia due to other causes.