Beyond technical feasibility: rethinking renal replacement therapy in children with profound medical complexity

This article argues that the technical feasibility of renal replacement therapy (RRT) should not be equated with meaningful clinical benefit for children with profound medical complexity and severe neurodevelopmental impairment. Drawing on paediatric palliative care literature and a clinical case of end-stage kidney disease, the authors contend that, while dialysis or transplantation may improve renal parameters, they also increase procedural pain, hospitalisations, infections, sleep disruption and the emotional and practical burden on families. As these interventions rarely alter the child’s overall neurological or developmental trajectory, decisions should be guided by a comprehensive assessment of the child's best interests rather than by organ-specific outcomes or survival alone.