OBJECTIVES: Exercise is a promising approach for symptom management in hemodialysis patients who are typically very sedentary. This study evaluated the effects of gamified versus pedometer-based walking interventions on these patients' physical activity, physical function, fatigue, sleep quality, and hemodynamics. METHODS: A quasi-experimental single-blind study was conducted in three groups (two intervention and one control groups). It was carried out at the hemodialysis department in Mansoura University Hospital, Egypt, from October 2022 to 2023. A total of 94 patients were divided randomly into gamified (n = 31), pedometer (n = 31), and control (n = 32) groups. Randomization was done by dialysis scheduled time (first shift: pedometer group, second shift: gamified group, and third shift control group) rather than at the individual level, and the allocation ratio was approximately 1:1:1. The gamified group received a twelve-week smartphone-based gamified walking intervention, while the pedometer group received a twelve-week pedometer-based walking intervention. The control group did not receive any intervention. Step count, fatigue, sleep quality, physical function, and hemodynamic parameters were evaluated at baseline and after 12 weeks of intervention. RESULT: Post-intervention results indicated that patients in the gamified group significantly improved their step count, fatigue, and sleep levels compared to both the pedometer and control groups (P < 0.001). However, the groups had no statistically significant differences in physical function or hemodynamics. CONCLUSION: Hemodialysis patients who participated in a short-term, smartphone-based gamified walking intervention experienced increased step counts, reduced fatigue, and improved sleep quality. TRIAL REGISTRATION: Prospectively registered with ClinicalTrials.gov on 28/10/2022; registration number NCT05599646.