Kidney Support Therapy: Recent Advances

Acute kidney injury (AKI) in children remains a significant challenge, independently associated with increased morbidity and mortality. Historically, kidney support therapy (KST) for this vulnerable population was fraught with difficulties due to small patient size, required extracorporeal volumes, and the risk of hemodynamic instability. However, the last few decades have seen dramatic advances in technology and therapeutic strategies, transforming the landscape of pediatric KST. The introduction of neonatal-specific continuous KST machines, such as the CARPEDIEM, NIDUS, and the Aquadex system, marks a revolutionary step. These devices are designed with minimal extracorporeal volumes, enabling precise fluid balance control and highly efficient solute clearance. Hybrid therapies are increasingly being used to leverage advantages of intermittent and continuous modalities. Peritoneal dialysis (PD) remains an accessible and safe first-line treatment, particularly for hemodynamically unstable neonates or in resource-limited settings. Use of closed system, automated cyclers, and continuous flow PD have enhanced safety of PD in AKI. Advances in precision KST using artificial intelligence, regenerative therapies, and multidisciplinary collaborations constitute an emerging space to watch in coming years. Future research needs to prioritize trials to further refine and standardize KST for children with AKI, ultimately improving lifelong outcomes.