Kidney replacement therapy (KRT) is used to treat children and adults with acute kidney injury (AKI), fluid overload, kidney failure, inborn errors of metabolism, and severe electrolyte abnormalities. Peritoneal dialysis and extracorporeal hemodialysis/filtration can be performed for different durations (intermittent, prolonged intermittent, and continuous) through either adaptation of adult devices or use of infant-specific devices. Each of these modalities have advantages and disadvantages, and often multiple modalities are used depending on the scenario and patient-specific needs. Traditionally, these therapies have been challenging to deliver in infants due the lack of infant-specific devices, small patient size, required extracorporeal volumes, and the risk of hemodynamic stability during the initiation of KRT. In this review, we discuss challenges, recent advancements, and optimal approaches to provide KRT in hospitalized infants, including a discussion of peritoneal dialysis and extracorporeal therapies. We discuss each specific KRT modality, review newer infant-specific devices, and highlight the benefits and limitations of each modality. We also discuss the ethical implications for the care of infants who need KRT and areas for future research.

中文翻译：

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婴儿肾脏替代治疗的最新进展：综述

肾脏替代疗法（KRT）用于治疗患有急性肾损伤（AKI）、液体超负荷、肾衰竭、先天性代谢缺陷和严重电解质异常的儿童和成人。通过调整成人设备或使用婴儿专用设备，可以进行不同持续时间的腹膜透析和体外血液透析/过滤（间歇、长时间间歇和连续）。这些方式中的每一种都有优点和缺点，并且通常根据情况和患者的具体需求使用多种方式。传统上，由于缺乏婴儿专用设备、患者体型较小、所需的体外容量以及 KRT 启动期间血流动力学稳定性的风险，这些疗法在婴儿中实施一直具有挑战性。在这篇综述中，我们讨论了为住院婴儿提供 KRT 的挑战、最新进展和最佳方法，包括腹膜透析和体外治疗的讨论。我们讨论每种特定的 KRT 模式，回顾较新的婴儿专用设备，并强调每种模式的优点和局限性。我们还讨论了护理需要 KRT 的婴儿的伦理影响以及未来研究的领域。