Objective To evaluate the impairment of the right ventricular systolic function of patients with end-stage chronic renal disease (ESRD) with normal left ventricular ejection fraction (LVEF). Methods Real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging(3D-STI) were employed in the right ventricular systolic function measurement. 25 healthy volunteers were enrolled as the control group. 43 ESRD patients were enrolled according to the Kidney Disease Improving Global Outcomes (KDIGO) guidelines who were undergoing regular hemodialysis therapy with preserved LVEF. Patients were divided in to ESRD group and ESRD complicated with pulmonary hypertension group according to whether he/she complicated with pulmonary hypertension. The diameter of the right ventricular index of myocardial performance (RIMP) were measured. The global longitudinal strain of free wall (3DGLS) was obtained by using 3D-STI. Real-time three-dimensional echocardiography was performed to measure right ventricular volume (EDV, ESV), ejection fraction (3DRVEF), calculate right ventricular output per minute (RVCO). Record fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE). Results ①Compared with the control group, EDV, ESV, RVCO, RIMP increased in ESRD group and ESRD complicated with pulmonary hypertension group, 3DRVEF, TAPSE, FAC decreased (P <0.01); RVD1, RVD2, RVD3 in ESRD group were not statistically significant (P> 0.05); RAD, RVD1, RVD2, PA, SV were increased in the ESRD combined with pulmonary hypertension group (P <0.05). Compared with the ESRD group, EDV, ESV, and RVCO in the ESRD complicated pulmonary hypertension group were increased, while the 3DRVEF, TAPSE, FAC were decreased (P <0.05). ②The absolute value of 3DGLS decreased significantly in both the two groups compared to the control (P <0.01). ③Correlation analysis shows that the absolute value of 3DGLS is strongly correlated with 3DRVEF, TAPSE, FAC, RIMP (r =0.7701, 0.6206, 0.5922, -0.5475, P <0.01). Conclusion Real-time three-dimensional echocardiography and three-dimensional speckle tracking imaging can be applied to evaluate the right ventricular systolic function of LVEF-preserved ESRD patients undergoing hemodialysis in the early stage of the disease and more sensitive than 2D echocardiography.