Acute kidney injury (AKI) in children admitted to pediatric intensive care unit is associated with high mortality and morbidity and greater hospital stay. Commencement of kidney replacement therapy (KRT) can be a life-saving supportive therapy that can reduce the mortality and fluid overload in critically ill children with AKI. Field of critical care nephrology has made a lot of progress in the last three decades. With advancements in technology, the modes of treatment have undergone significant transformation as well. Modalities of KRT can be continuous or intermittent, and the selection of modality depends on the hemodynamic status and clinical condition of the child. Availability of resources, expense, and local expertise also play a crucial role while deciding the modality. For optimal delivery of KRT, it is imperative to consider the timing of initiation and the prescription of each dialytic session which might vary depending on the etiology of the underlying disease. Although peritoneal dialysis remains quite safe and cost-effective, continuous kidney replacement therapy (CKRT) is the preferred modality nowadays as it offers better metabolic control and accurate fluid removal. However, delivering CKRT in newborns can be quite challenging and research is being done across the globe to develop dedicated neonatal machines.