Introduction: Hybrid dialysis is defined as the combination of peritoneal and haemodialysis. It is a strategy that can be utilised in patients requiring intense dialysis where a single modality has failed. Cardiac dysfunction is a known complication of advanced renal failure which can make renal transplantation difficult. We report a patient with prolonged severe cardiac dysfunction who underwent a successful renal transplant following hybrid dialysis. Case presentation: A 5.6-year-old girl with congenital nephrotic syndrome due to NPHS2 mutation was followed up from early infancy . Her renal functions gradually deteriorated age of 3.8 years. She was commenced on haemodialysis following rapid progression to Stage 5 chronic kidney disease following an episode of severe pneumonia requiring ventilator support age of 4.5 years. Subsequently she had repeated episodes of cardiac failure requiring emergencyhaemodialysis. Repeated 2D-Echocardiogrammes revealed severe left ventricular dysfunction with ejection fraction(EF) ranging from 30-40%. Haemodialysis was intensified to alternate-day dialysis but no improvement in cardiac function resulted. She was therefore commenced on hybrid dialysis with 3 times a week haemodialysis and 5 cycles a day continuous ambulatory peritoneal dialysis. This resulted gradual improvement in cardiac function with EF reaching 50-55%. She underwent a successful live donor kidney transplant from the father at 5.4 years of age and was discharged with a serum creatinine of 42μmol/L. On subsequent review cardiac function had improved further (EF 60-65%). Conclusions: This case report highlights the importance of considering hybrid dialysis in patients with severe cardiac dysfunction to improve cardiac function prior to renal transplantation.