Background: End stage renal disease (ESRD) is the final stage of CKD, affecting around 7.5 million people globally. Haemodialysis (HD) being the life saving treatment, also has serious impacts on patient’s medical, social and psychological well being, leading to medication non-adherence. Medication adherence is a cardinal element of any treatment, which can prevent the incidence of morbidity and mortality. Thus, current research aimed to assess medication adherence in ESRD patients undergoing HD. Methods: After obtaining IEC approval, this study was initiated in HD unit with 80 eligible patients using a pre validated questionnaire, modified version of Greek-Simplified Medication Adherence Questionnaire for Haemodialysis (GR-SMAQ HD). It evaluates adherence status for 3 domains, namely medication, HD session and Diet/Fluid restrictions. Total score of 8 indicates greater adherence. All collected data were tabulated and analyzed using SPSS 20.0 version. Results: Out of 80 patients, 58 were male and 22 female, with average age of 46.41 ± 8.02. Assessment of individual domains showed: 91.25% patients had greater adherence for HD session, followed by medication and fluid/diet (28.7% & 22.5%). Based on total scoring, only 7.5% had greater adherence level, remaining 92.5% belonged to moderate/poor adherence level, while no participant had zero adherence. Also showed significant correlation (P<0.05) for patients age, employment status and income status. Conclusion: Thus, result explored that only 7.25% patients had greater adherence level. So, it emphasizes that periodic evaluation on medication adherence by health care workers is highly essential to elevate the treatment success.