Background: Children with chronic renal disease can experience heart difficulties as a result of their condition. Objective: To evaluation ofcardiac complications using Doppler tissue imaging among Children with end-stage renal disease. Subject and Methods: This study was conducted on 40 children with chronic renal failure (17 male and 23 female) their ages ranged from 8 years to 17 years attending the Nephrology Unit of the Pediatric Hospital Zagazig University. All children were subjected to thorough history taking, complete detailed clinical examination, and laboratory investigations. All cases and control were assessed by tissue Doppler velocity and strain imaging before and after dialysis. Results: Tissue Doppler Imaging (TDI) assessment of systolic functions using lateral and septal mitral velocity (S) in cases is decreased significantly in predialysis cases more than control but did not show significant change after dialysis, also septal S of tricuspid is reduced significantly in cases predialysis than control but did not show significant change after dialysis. TDI assessment of septal mitral & tricuspid E′ &E′/A′ showed a significant reduction in predialysis cases more than control but did not show any change after dialysis, also lateral mitral &tricuspid E′&E′/A′ is decreased significantly in cases more than control but showed a significant decrease after dialysis. Conclusion: children with chronic renal failure (CRF) have significant cardiac abnormalities, TDI is a superior diagnostic method than conventional echocardiography in the diagnosis of systolic dysfunction as in our cases that appeared normal by conventional echocardiography. Also, TDI is less load-dependent in septal mitral & tricuspid E′&E′/A′