A 39 YRS OLD WITH CKD ON MHD Chief complaints: Patient c/o SOB since 3 months HOPI : Patient was apparently asymptomatic 1 year ago then he developed blurring of vision and was diagnosed with hypertension and CKD with hypertensive changes in the right eye since then he was on conservative therapy stayed in hospital for 5 days in ICU . 3 months patient developed SOB grade II-III and pitting type of pedal edema ( b/l )and significant weight loss No H/o pyuria, palpitations, chest pain. H/o orthopnea, PND Then he underwent dialysis at NIMS punjagutta ( right IJV- 3 sessions) HISTORY OF PAST ILLNESS: k/c/o HTN since 1year N/k/c/o DM, epilepsy, asthma, CAD, TB, CVA, thyroid disorder. PREVIOUS HISTORY: No similar complaints in the past. PROVISIONAL DIAGNOSIS CKD ON MHD PERSONAL HISTORY: Appetite:normal Diet:mixed Bowel and bladder:regular Sleep: adequate No addictions FAMILY HISTORY: K/c/o HTN in the family GENERAL EXAMINATION: Patient is conscious and coherent Moderately built and mode