Clinical Research Directory

Inclusion Criteria: 1. Fifty patients with CKD, are on hemodialysis for longer than threemonths 3 sessions/ week. 2. Theirageswillrangefrom40 to 55yearsold. 3. Their body mass index is more than 18.5 and less than 29.9 %. 3-All patients have hemodynamic stability over the month before beginning the program. Exclusion Criteria: * 1\. Severe Chest diseases(either obstructive or restrictive). 2. Clinical signs of a severe cardiac event.(eg, severe atherosclerosis, congestive heart failure), 3. Severepsychiatricorcognitiveimpairment,whounabletofollowcomment. 4. Neurological disorders affecting respiratory muscles or any muscular dystrophies(cervical disc or bulge). 5\. Patients with severe self-limiting illness (e.g., cancer). 6. peripheral artery disease in lower extremities. 7. Systolic blood pressure \< 180 mmHg, diastolic blood pressure more than 105 mmHg, or heart rate above 120 bpm during dialysis. 8\. Patient with uncontrolled- diabetes.