Introduction: Chronic kidney disease has a progressive impairment of kidney functions which enrols bone, mineral and endocrine involvement into its pathophysiology. Secondary hyperparathyroidism is awell-recognised common complication of CKD potentially contributing to impaired left ventricular functionprimarily due to mechanisms such as vascular calcification, myocardial fibrosis anddirect effects on cardiac muscle cells caused by elevated parathyroid hormone (PTH) levels.This article involves retrospective analysis of 56 patients with end stage renal disease for renal transplantation to our institution where high PTH levels were found to be correlating with severity of cardiac involvement. Aims and objectives 1. To evaluate secondary hyperparathyroidism and correlate with ejection fraction of left ventricle in patients with ESRD presenting for renal transplantation. 2. To infer the range of serum PTH contributing to poor ejection fraction of left ventricle. 3. To examine serum Calcium and Phosphorus levels that trigger secondary hyperparathyroidism. 4. To analyse right ventricular systolic pressure as second factor of cardiac involvement due to PΤΗ in ESRD Materials and methods: All patients with ESRD who were evaluated by nephrologist and referred to preanaesthetic evaluation for renal transplantation were included in the study.Study period: June 2024 to December 2024.The pre anaesthetic charts were examined retrospectively and parameters includingpatient demographics, parathormone (serum PTH) levels, Ejection fraction, right ventricular systolicpressure were noted, tabulated and analysed.All patients have undergone successfulrenal transplantationand have stable kidney functions in the post-operative period. Results: The serum parathormone (PTH) levels ranged from 30 to 1200 pg/dl while serum Calcium levels between 6 to 8 mg/dl. The high PTHshowed a p-value of 0.08 with RVSP 0.4 with EF and 0.5 with Serum calcium.Negative correlation was noted between PTH levels and serum Calcium and ejection fraction. Conclusion: Parathyroid hormone has been labelled as one of the uremic toxin causing cardiovascular effects in ESRD. The serum PTH levels may be considered as an indicator of severity of left ventricular dysfunction and pulmonary hypertension in ESRD.