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Background: Cardiac systolic dysfunction was potentially found in adult patients with end-stage renal disease (ESRD) who have preserved left ventricular ejection fraction (EF%). In children with ESRD, little data are available on early changes in myocardial function. This study aimed to detect the early changes in myocardial mechanics in pediatric patients with ESRD using speckle tracking echocardiography (STE). Methods: Thirty ESRD children receiving hemodialysis (HD) and30 age-matched controls were prospectively studied. Patients underwent echocardiographic studies before and after HD. Left ventricular longitudinal strain (LS), circumferential strain (CS), and radial strain (RS) myocardial deformation parameters (strain, strain rate) were evaluated by STE. Results: The LS was significantly reduced in pre-HD and post-HD patients compared with controls (P =.000). Controls showed the highest global longitudinal strain. The RS measurements did not differ significantly among the studied groups except for the inferior segment that is significantly reduced after HD compared with controls (P <.05). The CS was significantly reduced in pre-HD and post-HD patients compared with controls at the lateral and posterior segments (P =.035 and P =.013, respectively). Conclusion: Speckle-tracking echocardiography might detect early changes in myocardial mechanics in children with ESRD with preserved EF%. [ABSTRACT FROM AUTHOR]