Inclusion Criteria:  All patients who were undergoing Hemodialysis or were intended to start HD within three months between the age of 20 years to 70 years were included in the study  Exclusion Criteria:  Age less than 20 years or more than 79 years In patients who are not expected to start dialysis in next 3 months Non-consenting patients Patients with diagnosed carcinoma whose life expectancy is less than a year. Patients with un-controlled hypertension on multiple regimes of antihypertensive Patients allergic to ACE inhibitors