Introduction: Cardiovascular disease is the main cause of death in Chronic Kidney disease (CKD) patients especially for those on dialysis. Left ventricular echocardiography changes are common. N-terminal pro-Brain Natriuretic peptide (NAP) is a sensitive predictor for ventricular stress.  
Aim of the Study: Our aim is to assess left ventricular Echocardiography abnormalities in CKD patients and their relation to serum NT pro BNP levels.
Methods: TheStudy included; 51 patients with different stages of CKD (21 patients were (CKD1-4) on predialysis conservative treatment, 30 patients with (CKD 5) on hemodialysis), and 20 healthy control group. Patients were subjected to echocardiography and serum measurement of BNP by enzyme linked immunosorbent assay.
Results: Abnormal left ventricular geometry patterns were seen in 17/21 (81%) CKD pre dialysis patients (concentric hypertrophy in 8 patients, eccentric hypertrophy in 8 patients and concentric remodeling in one patient). Those on dialysis 28/30 (93%) showed abnormal left ventricular geometry patterns (23 had concentric hypertrophy, 4 had eccentric hypertrophy and one patient had concentric remodeling). Mean NT pro BNP level was significantly higher in ESRD on dialysis (182.49 ± 136.57) vs pre dialysis group (29.72 ± 34.77) and control group (1.13 ± 2.97) (p < 0.001). Total patient sample (51cases) showed significant positive correlations between NT pro BNP level with hypertension, left ventricular mass (LVM), LVM^2.7, LVM², relative wall thickness (RWT) and serum creatinine (p = 0.0007, 0.01, 0.0007, 0.0005, 0.0002 respectively),significant negative correlation with ejection fraction (P = 0.04).
Conclusion: Measuring plasma concentration of BNP, may be useful for the identification of CKD patients with abnormal left ventricular Geometry.
Recommendations: Routine echocardiography is recommended in early stages of CKD.