Peritoneal dialysis in the treatment of neonatal acute kidney injury

Peritoneal dialysis (PD) remains a mainstay of kidney replacement therapy (KRT) for neonatal acute kidney injury (AKI), despite recent advances in extracorporeal technologies. Its widespread use is supported by technical simplicity, good hemodynamic tolerance, avoidance of vascular access and systemic anticoagulation, and broad applicability across both high- and low-resource settings. However, neonatal PD presents unique anatomical, physiological, and technical challenges that are only partially addressed in current pediatric guidelines. As a result, many aspects of its management remain informed by extrapolation from older pediatric populations and clinical experience. This educational review provides a practical, evidence-based approach to the management of acute PD in neonates with AKI, integrating available evidence with bedside considerations to guide clinical practice while identifying areas requiring further neonatal-specific research.