Background: Patients with chronic kidney disease (CKD) manifest an increased prevalence of cardiovascular morbidity and mortality compared with age-matched persons, and this relationship is directly proportional to the severity of CKD. After age, left ventricular hypertrophy (LVH) is considered to be the strongest independent predictor of cardiovascular disease and events, cardiovascular death and total mortality. In CKD patients, LVH contributes to diastolic dysfunction, congestive heart failure, arrhythmia and sudden death. Aim of the Work: The aim of this study is to clarify the relationship between ESRD and left ventricular dysfunction Methods: All patients were subjected to the following :: Complete history and physical examination, Routine laboratory investigations including: Complete blood picture,Blood urea and serum creatinine, Random blood suger, calcium, phosphors,, uric acid urine analysis, PTH Special investigations in the form of 2D echocardiography. Results: The collected data were computerized and statistically analyzed using SPSS program (Statistical Package for Social Science) version 24.