Background: Respiratory system pathologies are one of the most frequent causes of hospital admission for patients to chronic dialysis. Chest X-ray is an accessible and cost-effective way to diagnose such comorbidities and guide their management. The study aim was to assess the efficiency of follow-up chest X-rays performed twice per year for evaluation of chronic dialysis in outpatients. Material and methods: The study included 350 outpatients who underwent dialysis in Chisinau Dialysis unit of “BB-Dializa” S.R.L. during 2016. Basing on the National Clinical Protocol each patient except those on holiday dialysis underwent a chest X-ray in 3 projections twice per year. Additional chest X-rays could be performed if clinically indicated. Results: Simple chest X-ray in 3 projections has demonstrated to be an efficient instrument in diagnosis of both acute and chronic pulmonary, mediastinal and cardiac pathology. During the study period, 2 cases of BAAR+ tuberculosis were diagnosed and successfully treated. A total of 12 cases of pneumonia, 26 cases of chronic bronchitis, 1 case of primary lung cancer and 1 case of pulmonary metastases were also diagnosed at the routine follow-up chest X-rays. A total of 9 patients required hospital admission, while the rest underwent ambulatory treatment. Further investigations of the patient with lung metastases revealed a pancreatic malignancy. Conclusions: Proposed imaging management approach to the chronic dialysis outpatients has demonstrated its viability and efficiency in this cohort of 350 outpatients.