# Pediatric Dialysis: From Acute Kidney Injury to Chronic Renal Replacement Therapies: Challenges and Perspectives in Resource-Limited Countries

## TL;DR

Pediatric kidney failure is a major health issue, especially in resource-limited countries like Algeria, where access to effective dialysis and transplantation is limited.

## Contribution

The paper provides an updated review of pediatric kidney failure management and highlights challenges specific to resource-limited settings in the Maghreb region.

## Key findings

- Pediatric kidney failure significantly impacts survival and development in low- and middle-income countries.
- Access to dialysis and transplantation is limited in the Maghreb region due to organizational and resource constraints.
- Strengthening peritoneal dialysis and kidney transplantation programs is critical for improving outcomes in these regions.

## Abstract

Background: Pediatric kidney failure, whether acute or chronic, constitutes a major public health issue because of its impact on survival, linear growth, neurocognitive development, and long-term quality of life. While high-income countries have markedly improved outcomes through early diagnosis, advanced dialysis technologies, and kidney transplantation, management remains limited in low- and middle-income countries, particularly in the Maghreb region. Objective: This review aims to provide an updated synthesis of pediatric kidney failure, with emphasis on renal replacement therapy modalities and the specific challenges encountered in resource-limited contexts, particularly in Algeria. Methods and Content: We successively address the pathophysiological and clinical bases of pediatric acute kidney injury and chronic kidney disease, followed by a discussion of available therapeutic strategies: peritoneal dialysis, intermittent hemodialysis, continuous renal replacement therapy, and pediatric kidney transplantation. Particular attention is given to organizational constraints, actual availability of modalities, limited access to consumables and immunosuppressive therapies, and the specificities of pediatric kidney care in the Maghreb region in comparison with international recommendations. Perspectives: Improving outcomes for children with kidney failure in Maghreb countries requires a multidimensional approach integrating early screening, strengthening peritoneal dialysis programs, structured development of pediatric kidney transplantation, and enhanced regional and international collaboration. Reinforcing local research capacity and participation in international registries are essential steps toward reducing disparities in care and adapting global guidelines to local realities.