الفهرس 
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Abstract
Introduction: Cardiovascular autonomic neuropathy (CAN) involving both sympathetic and parasympathetic nervous system is common in patients with CKD especially diabetic patients. The severity of neuropathy is correlated to the severity of CKD . Assessment of CAN may be a useful and easy clinical tool to predict cardiovascular morbidity in CKD patients with apparently normal cardiac examination and conventional echocardiography. Though common in CKD patients, the relation of CAN to subclinical left ventricular myocardial dysfunction was not previously assessed in these patients. • Aim of the work: The aim of the present study is to evaluate Cardiovascular autonomic neuropathy in non-diabetic CKD patient and its relation to subclinical left ventricular dysfunction evaluated by speckle tracking echocardiography.
• Patient and methods: This cross section observational study was carried out on 46 patients (40 males and 6 females) with chronic kidney disease at Mansoura University Hospitals for one year from August 2018 to Feburary 2019. Patients were divided into 2 groups according to presence or absence of Cardiac Autonomic Neuropathy • Results: The median age was 49 years (range =40.7-53 years),Among the cases, 31 patients were smokers, 45 patients were hypertensive, 19 patients were HCV positive and 12 patients had renal stones.As regards the CKD stage, 2 patients had grade II, 6 patients had grade III, 17 patients had grade IV and 21 patients had grade V.Cardiovascular autonomic neuropathy (CAN) was present in 35 (76.1%) of patients.There was no statistically significant difference existed between cases with and without CAN as regards median age, sex, HTN, presence of renal stones, CKD Stage, Sr Cr and GFR by CKD EPI formula.There was a statistically significant difference existed between both group as regards smoking, HCV infection and GLS.There were no statistically significant differences between both groups in NSAIDS and ACEIS intake. Conclusion: This study shows that GLS is just a predictor of subclinical LV dysfunction which reflects cardiovascular risk in CKD patients with apparently normal cardiac examination and echocardiography.