The present study indicated that PHT was a common condition in ESRD patients undergoing hemodialysis via AV access. Estimation and follow-up of Pulmonary artery pressure (PAP) using Doppler echocardiography may be indicated in all patients with ESRD undergoing hemodialysis. Patients with PHT have a lower levels of hemoglobin and higher levels of interdialytic weight gain. As regard pulmonary embolization as a cause of pulmonary hypertension our study show statistical significance (p <0.05) but this result shouldn’t’t be taken in consideration due to small sample size Increased unexplained, frequently symptomatic Pulmonary Hypertension is a call for further investigation.