Despite performing dialysis regularly, most hemodialysis patients still showed inadequate dialysis adequacy as seen from the insufficient scores of Kt/V and URR and the fatigue felt by the patients. It was assumed that exercises done while undergoing hemodialysis could improve dialysis adequacy and reduce fatigue. This study aimed to find out the effect of an intradialytic range of motion (ROM) exercise on dialysis adequacy and fatigue of the patients undergoing hemodialysis. This study is an experimental using a time-series design. The data sampling was taken randomly consisting of intervention group (n=23) and control group (n=24). The intervention, which was ROM exercises involved an active movements of extremities that were conducted for eight weeks, twice a week for 30 minutes while undergoing hemodialysis with exercise intensity of 50-60% of resting heart rate. After eight weeks, the average score of Kt/V increased by 13% (p<0.001) and the URR increased by 6% (p< 0.001)and the acquired fatigue score decreased by 9.5% (p < 0.001). The result of this study showed that different exercise dosages covering types, durations, frequencies, and intensities could give different effects on the scores of Kt/V and URR. Intradialytic ROM exercise is highly recommended for patients undergoing hemodialysis because it can increase dialysis adequacy and reduce fatigue so that the patients’ life quality can be improved.