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Dialysis for children — why PD is the default in young kids, the differences from adult dialysis, growth and nutrition, and the path to transplant.
Evidence reviewed & updated: 2026-08 — reflects the latest published trials and guidelines.
Dialysis in children is a bridge — to transplant — and it's engineered differently than adult dialysis: peritoneal dialysis is the default in young children (home-based, needle-free, school-friendly), growth and nutrition get center stage, and the care team extends into the classroom. The goal is always the transplant that ends dialysis.
For infants and young children, PD wins on logistics: it runs at home, mostly overnight on a cycler, needs no needles, and lets the child attend school and live a childhood. The family becomes the care team — trained and supported by the unit — with the exit-site care discipline that prevents peritonitis.
HD is used for older children (especially teens, who often prefer it), for rapid clearance needs, and when the peritoneum isn't an option. In-center pediatric HD units are specialized — children are not treated on adult machines with adult settings.
Dialysis children face a metabolic tax: uremia suppresses appetite, and the dialysis prescription must be nutrition-adjusted — higher calorie intake per kg than adults, sometimes with tube feeds and gastrostomy to meet targets. Growth hormone is used when growth falters despite nutrition; treating anemia and acidosis supports growth too.
The pediatric renal dietitian is a central team member — the fluid and potassium rules are the same but the calorie math is different.
Every pediatric dialysis program works toward transplant: living-donor evaluation, listing, and preemptive transplant (before dialysis is ever needed) when the donor and timing allow — preemptive transplants have the best graft outcomes in children.
Meanwhile, life continues: school attendance with nurse liaison, sports with access protection, and age-appropriate psychosocial support — the team includes a psychologist because dialysis in childhood is a family event.
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