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Overview of renal replacement therapy (RRT) for children with chronic kidney disease

Lesley Rees, MD, FRCPCH
Bradley A Warady, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Pediatric chronic kidney disease (CKD) is a chronic, progressive disorder. However, the rate of decline varies with age, underlying etiology, and clinical findings. An improvement in renal function is often seen in the first two years of life, and this may be followed by a period of stability until puberty, when declining function develops [1]. Children with glomerular disease, proteinuria, and/or hypertension are more likely to have a progressive fall in renal function regardless of age [2]. Nevertheless, as the estimated glomerular filtration rate (GFR) declines to less than 30 mL/min per 1.73 m2 (CKD stage 4), preparations for renal replacement therapy (RRT) are needed [3]. The family and, if appropriate, the child should be provided with information related to preemptive kidney transplantation, peritoneal dialysis (PD), and hemodialysis (HD).

The choice and timing of RRT for children with CKD are reviewed here. Topic reviews that include more comprehensive descriptions of the different forms of RRT for pediatric CKD, including complications and outcome, are discussed separately. (See "Hemodialysis for children with chronic kidney disease" and "Chronic peritoneal dialysis in children" and "General principles of renal transplantation in children" and "Complications of renal transplantation in children".)


A classification schema for CKD in children is based upon the level of kidney function (defined by glomerular filtration rate [GFR]) as follows (table 1) [4]:

G1 − Normal GFR (≥90 mL/min per 1.73 m2)

G2 − GFR between 60 and 89 mL/min per 1.73 m2


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Literature review current through: Sep 2016. | This topic last updated: Jul 6, 2016.
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