This study was designed to evaluate cardiac changes in patients with end stage renal failure (ESRF) . It included 45 patients wit ESRF ,they were divided into 2 groups .Group 1 consisted of 30 patients under conservative treatment, they were 19 males and 11 females and their ages ranged from 6-12.5 years . Group 2 included 15 patients under peritoneal dialysis , they were 10 males and 5 females and their ages ranged from 5 -13 years . Also 15 healthy children of matched age and sex were taken as controls (group3) This study showed statistical significant increase in LVM,LVMI,LVESD,LVEDD,IVS,LVPWT and AO root dimension ARD in both group 1 and group 2 in comparison to group 3 .Also E wave peak velocity ,E/A ratio and LV ejection time showed statistical significant between G1,G2 and G3 . LVMI showed significant positive correlation with systolic blood pressure in G1,whil LV ejection time showed significant negative correlation with systolic blood pressure in G1 . G2 showed significant negative correlation of systolic blood pressure with FS and significant positive correlation between systolic blood pressure and LVEDD,ARD and LA dimension .