# Dialysis and Renal Replacement Therapy in Children

> Dialysis and renal replacement therapy in children for NEET-PG Paediatrics covering indications, peritoneal dialysis, haemodialysis access and CRRT.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/dialysis-and-renal-replacement-therapy-in-children
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Nelson Textbook of Pediatrics; KDIGO Clinical Practice Guideline for Acute Kidney Injury
- How to cite: "Dialysis and Renal Replacement Therapy in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/dialysis-and-renal-replacement-therapy-in-children

## Direct answer

Dialysis in children replaces kidney function in acute kidney injury or end-stage kidney disease, and peritoneal dialysis is usually the preferred modality for infants and young children. The choice depends on the child's size, vascular access and haemodynamic stability, and continuous therapy suits critically ill children whose circulation cannot tolerate intermittent sessions.

## What you must remember

- **Indications:** hyperkalaemia, acidosis or fluid overload not corrected by medical therapy, plus uraemic pericarditis, encephalopathy or removal of a dialysable toxin.
- **Preferred modality:** peritoneal dialysis for infants and most young children, avoiding vascular access and allowing gentle, often home-based therapy.
- **Haemodialysis access:** an arteriovenous fistula is the long-term goal, while a tunnelled catheter serves urgent or temporary needs.
- **Catheter site:** the internal jugular vein is preferred, since subclavian lines cause central venous stenosis that destroys future fistula sites.
- **CRRT:** continuous therapy for haemodynamically unstable children with acute kidney injury, removing fluid and solutes slowly over many hours.
- **Disequilibrium:** rapid urea removal during haemodialysis can cause headache, vomiting and seizures, so slower sessions protect high-risk children.
- **Peritonitis:** cloudy peritoneal effluent with a white cell count above 100/µL (over 50% neutrophils, after a dwell of at least 2 hours) is peritonitis, requiring prompt culture and intraperitoneal antibiotics; coagulase-negative staphylococci are the commonest organisms.
- **Transplant:** the best long-term option for most children with end-stage kidney disease, improving growth and neurocognitive outcomes.

## A bedside pathway for choosing the modality

A ten-month-old with oliguric acute kidney injury has fluid overload and a potassium that medical therapy cannot control. The team must decide the modality before the child's circulation worsens.

1. **Confirm the indication:** Refractory hyperkalaemia, acidosis, fluid overload or uraemic complications set the indication, not a fixed creatinine value.
2. **Assess stability:** Hypotension, poor perfusion or raised intracranial pressure favour continuous therapy over intermittent haemodialysis.
3. **Choose the modality:** Peritoneal dialysis suits stable infants and young children with no abdominal contraindication, whereas older or larger children may use haemodialysis.
4. **Secure access:** A peritoneal catheter is placed surgically or percutaneously, and haemodialysis starts through a tunnelled internal jugular catheter.
5. **Set the prescription:** Dose by body size, limit rapid urea removal in high-risk children and monitor electrolytes, blood pressure and fluid balance.
6. **Plan the long term:** Refer early for transplant assessment and track growth, bone health and anaemia throughout.

## Where the exam sets its traps

Errors here cluster around access choice and early recognition of dialysis complications.

- **Trap:** choosing haemodialysis for an infant because it clears solutes faster. — **Correct:** peritoneal dialysis is the preferred modality in infants, avoiding the vascular access problems that make haemodialysis hard at that size.
- **Trap:** using a subclavian line for urgent haemodialysis access. — **Correct:** subclavian stenosis in children destroys future access sites, so a tunnelled internal jugular catheter is preferred.
- **Trap:** dismissing cloudy peritoneal effluent as a routine finding. — **Correct:** cloudy fluid with a raised cell count indicates peritonitis, needing prompt culture and antibiotics.

## Frequently asked questions

### When is dialysis indicated in a child with acute kidney injury?

Dialysis is indicated for hyperkalaemia, severe acidosis or fluid overload that medical therapy cannot control, and for uraemic pericarditis or encephalopathy. Indications are clinical rather than based on a single creatinine threshold.

### Why is peritoneal dialysis preferred in young children?

Peritoneal dialysis avoids vascular access, uses the child's own peritoneal membrane and can be performed gently, often at home. These advantages make it the preferred modality for infants and most young children.

### What is the main advantage of CRRT in critically ill children?

CRRT removes fluid and solutes slowly over many hours, causing far less haemodynamic instability than intermittent haemodialysis. It suits children with shock or raised intracranial pressure who cannot tolerate rapid changes.

### Why must rapid urea removal be avoided in haemodialysis?

Rapid urea clearance can cause dialysis disequilibrium syndrome, with headache, vomiting and seizures. Slower sessions or adjusted dialysate reduce this risk in high-risk children, such as those with very high urea levels.