Continuous renal replacement therapy (CRRT) allows gradual, precise removal of excess fluid and solutes. Special considerations are necessary for children who require CRRT because of their smaller circulating blood volumes and the potential for hemodynamic instability associated with the initiation of CRRT. In critically ill children, the CRRT circuit is often primed with blood rather than saline to prevent excessive hemodilution. Two innovative techniques have been designed to limit repeated exposure to donated blood, reduce hemodynamic instability associated with priming of the circuit with blood, and limit interruptions in CRRT. A circuit-to-circuit exchange technique offers a safe, effective alternative method for CRRT circuit changes in small children and infants. A concurrent technique that combines CRRT with plasmapheresis is effective in preventing interruptions of therapy when patients require multiple modes of supportive treatment.

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