Continuous kidney replacement therapy (CKRT) has evolved beyond kidney replacement into an essential extracorporeal organ support modality for critically ill children with acute kidney injury, fluid overload, metabolic derangements, and hemodynamic instability. However, evidence describing pediatric CKRT practice in low and middle income countries remains limited. This study aimed to characterize the clinical indications, prescription patterns, and outcomes of CKRT at a national referral center.

We conducted a retrospective case series of consecutive children who received CKRT at a national referral hospital between June 2021 and July 2026. Demographic characteristics, CKRT indications, treatment prescriptions, and clinical outcomes were analyzed descriptively.

Nine children underwent CKRT during the study period. Median age was 11.8 years (range 0.3–17.8), median body weight 31.5 kg (7.6–77.0), and median body surface area 0.8 m² (0.2–1.5); six patients (66.7%) were male. CKRT was initiated a median of 2 days after admission. The principal indications were oligo-anuric AKI (77.8%), metabolic acidosis (66.7%), hemodynamic instability requiring vasoactive support (66.7%), fluid overload (55.6%), and severe electrolyte disturbances (55.6%). Septic shock was the leading underlying diagnosis (44.4%), whereas complement-mediated atypical hemolytic uremic syndrome, tumor lysis syndrome, advanced chronic kidney disease, diabetic ketoacidosis, and lupus nephritis each accounted for 11.1%. Median serum creatinine and blood urea nitrogen at CKRT initiation were 5.3 mg/dL and 124 mg/dL, respectively. CVVHDF was the predominant modality (66.7%), followed by CVVHF (22.2%) and CVVHD (11.1%). Three children (33.3%) survived with renal recovery, whereas six (66.7%) died from refractory multiorgan dysfunction.

CKRT provided individualized extracorporeal organ support across diverse pediatric critical illnesses. Clinical outcomes were largely determined by the severity of the underlying disease rather than renal dysfunction alone. Broader multicenter studies are warranted to optimize patient selection, CKRT prescription, and timing of initiation.