Backgrounds and purposes:It is unknown whether the characteristics of diastolic dysfunction exist in chronic renal failure (CRF). The aim of this study was to elucidate the usefulness of tissue Doppler imaging (TDI) for evaluation of LV diastolic dysfunction in CRF. Methods:We prospectively examined echocardiographic parameters mainly centered on representative of diastolic function of 40 patients on maintenance hemodialysis (HD;M:F=19:21, mean age=57짹14years) and 24 patients with hypertensive heart disease (HHD;M:F=13:11, mean age=63짹14years). Patients with mitral inflow E/A���1 were excluded. Results:There was no difference in left ventricular ejection fraction between two groups (63짹9% in HD and 63짹7% in HHD). LV mass index was 58.7.4짹19.3g/m2.7 in HD and 60.0짹16.8g/m2.7 in HHD (p=NS). Left atrial (LA) dimension was greater in HD than in HHD (4.2짹0.8cm vs 2.7짹0.5cm, p<0.0001). There were no significant differences in mitral E/A ratio, E velocity and E wave deceleration time between two groups. On TDI, E(a) velocity (0.10짹0.12 m/sec vs 0.17짹0.07 m/sec, p=0.014) and E(a)/A(a) (0.60짹0.19 vs 0.78짹0.35, p=0.009) were significantly lower in HD group. Mitral inflow E to E(a) velocity ratio (E/E(a) ratio) (7.1짹2.7cm in HD vs 3.7짹1.5cm in HHD, p<0.0001) and number of patients with E/E(a) more than 10 (indicative of LA pressure>15mmHg) (n=5, 12.5% in HD vs n=0, 0% in HHD, p<0.0001) were significantly different between two groups. Conclusion: Compared to the HHD patients, LA pressure seems to be elevated in HD patients. Therefore, the evaluation of LV diastolic function by the mitral inflow pattern may be not accurate. TDI of mitral septal annulus is useful to evaluate the diastolic function in CRF.