Introduction: Overhydration is the main contributory factor of left ventricular hypertrophy and closely associated with cardiovascular events in end stage renal disease (ESRD) patients. The aim of this prospective-study was to investigate the impact of strict salt and volume control on hypertension and cardiac condition in ESRD patients. Methods: A total of 12 peritoneal dialysis (PD) and 15 prevalent hemodialysis (HD) patients were enrolled. All patients either PD or HD were allocated to intervention of strict salt restriction according to basal hydration state of empty abdomen in PD and midweek predialysis HD which were estimated by body composition monitor (BCM) and echocardiography. Results: Mean ages were 48.3 +/- 16.7 years for PD, and 48.8 +/- 18 for HD patients. Extracellular water/height was 10.04 +/- 2.70 and 10.39 +/- 1.53 L/m in PD and HD groups. Systolic blood pressures decreased in PD and HD from 133.1 +/- 28 and 147.3 +/- 28.5 to 114.8 +/- 16.5 and 119.3 +/- 12.1 mmHg, respectively, (p<0.00). IDKA/DW were decreased from 3.26 +/- 1.6 to 2.97 +/- 1.63 % in HD group (p>0.05). LVMI and LAI were not increased in both groups. Conclusion: Strict salt and volume control in ESRD patients after assessment of hydration status with either using BCM or echocardiography provides better management of volume control leading to more precise cardiovascular protection.