The population of end-stage renal disease (ESRD) is increasing with higher mortality due to cardiovascular disease which is the leading cause of death in these patients. Cardiovascular disease is a frequent cause of death in patients with hemodialysis, with the ratio reported as 5–30 times higher than that observed in populations with normal kidney function. Valvular heart disease, pericardial effusion, systolic and diastolic ventricular dysfunction and pulmonary hypertension are common cardiac abnormality in these patients.