Objective The management (renal replacement therapy; RRT) of infants with end-stage renal failure (ESRF) continues to present not only ethical dilemmas but also a real practical challenge.

Methods We present 19 infants and toddlers, 12/19 with ESRF on RRT, 7/19 with chronic renal insufficiency (CRI) treated conservatively during the past 12 years. The mean age at the start of RRT was 3.5 months (14 days–4 years). Causes of ESRF: renal hypoplasia/dysplasia (6), autosomal recessive polycystic kidney disease (6), obstructive uropathies (5), congenital nephrotic syndrome (1), perinatal asphyxia (1). Overnight cycling peritoneal dialysis was the preferred initial option; infrequently continuous arteriovenous haemofiltration, venovenous haemofiltration or haemodialysis were used. Nasogastric tube feeding was used to optimise growth, nearly 40% of patients had gastrostomy (PEG). Caloric intake was 120% of recommended dose, protein intake 1.8–2.2 g/kg per day. Erythropoetin, salt supplementation, activated vitamin D were used in the majority of patients.

Results Children were placed on the transplant waiting list when they reached the weight of 10 kg. Six were grafted at the mean age of 4 years (2.8–5.2 years). Developmental outcome all of them is good. Two patients died (cardiopulmonary insufficiency, sepsis). Four patients are still on peritoneal dialysis, seven patients with CRI are treated conservatively.

Conclusions This intensive treatment of infants (connected with high mortality) can be successful if there is full compliance of a family and a skilled and resourced medical team.