EMERGENCY AND CRITICAL CARE MEDICINE: Edited by Jean E. Klig and Clifford W. Bogue: CRITICAL CARERenal replacement therapies for infants and children in the ICUSanderson, Keia R.a; Harshman, Lyndsay A.bAuthor Information aDepartment of Medicine-Nephrology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina bDivision of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, USA Correspondence to Lyndsay A. Harshman, MD, Division of Pediatric Nephrology, Stead Family Department of Pediatrics, University of Iowa, SE425 General Hospital, 200 Hawkins Drive, Iowa City, IA 52242, USA. Tel: +1 319 356 7249; fax: +1 319 384 9616; e-mail: firstname.lastname@example.org Current Opinion in Pediatrics: June 2020 - Volume 32 - Issue 3 - p 360-366 doi: 10.1097/MOP.0000000000000894 Buy Metrics Abstract Purpose of review Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT. Recent findings The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes. Summary Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.