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Background and objective: In adults, hemodialysis (HD)-induced ischemia causes reversible myocardial dysfunction (myocardial stunning) that is progressive with raised attendant mortality. Children share an increased risk for death from a spectrum of uremia-related cardiovascular abnormalities but in the absence of significant classical atheromatous coronary artery disease; therefore, we elected to assess children who were on HD for the occurrence of myocardial stunning to investigate the relative importance of characteristic uremic cardiovascular abnormalities in the development of ischemic cardiac injury.