Global pediatric kidney replacement therapy.

INTRODUCTION: Chronic kidney disease (CKD) is an important and growing global health concern in children, contributing substantially to morbidity and mortality. Pediatric end-stage kidney disease (ESKD) requires kidney replacement therapy (KRT) in the form of hemodialysis, peritoneal dialysis, or transplantation, yet access remains highly inequitable worldwide. MATERIALS AND METHODS: This review focuses on current knowledge regarding the burden of pediatric ESKD, available treatment options, and barriers to renal care, with particular attention to differences between high-resource and low-resource settings. Relevant updated DATA were extracted from the Google Scholar, PubMed databases, global registries. RESULTS: Glomerulonephritis and congenital anomalies of the kidney and urinary tract (CAKUT) are among the leading causes of ESKD in children, with regional variation influenced by environmental, infectious, and genetic factors. Despite substantial advances in KRT, children living in high-income and upper-middle-income countries account for most of those receiving treatment, while low- and middle-income countries face critical shortages of resources, infrastructure, and trained professionals. Mortality among children who do not receive appropriate therapy remains markedly higher than in the general pediatric population, underscoring the urgency of addressing these disparities. This review also outlines key mitigation strategies, including context-appropriate, cost-effective dialysis models, workforce development, and international efforts to strengthen pediatric kidney care. CONCLUSION: Addressing the burden of pediatric ESKD will require coordinated action to improve early detection, reinforce health systems, and expand equitable access to KRT globally, particularly in low-resource settings.