Inclusion Criteria:  - Patients with chronic renal disease (CKD) aged between 16 and 65 years will be included.  2- CKD are diagnosed based on criteria proposed by KDIGO (Kidney Disease: Improving Global Outcomes) in 2002  Exclusion Criteria:  Patients with structural heart disease (congenital or valvular heart disease). Patients with primary hypertension. Patients with obstructive or restrictive lung disease.