A 64-year-old man with a background of chronic kidney disease (CKD) was admitted to hospital for symptoms of uraemia and was subsequently initiated on haemodialysis (HD). On day 13 of HD, he developed per rectal bleeding with a significant drop in his haemoglobin (Hb) level. Oesophagoduodenoscopy (OGD) was performed and showed several antral and duodenal ulcers. Colonoscopy was unremarkable. He was started on high-dose PPI and his Hb level remained stable with no recurrence of symptoms. This case report highlights the association between HD and the increased risk of developing peptic ulcer disease (PUD) in patients with end-stage renal failure. Abdominal symptoms are common in the primary care setting and it is crucial for family physicians to be able to recognise the red flags of PUD in this group of high-risk patients as timely referral and intervention reduces morbidity and mortality.