279ACUTE RENAL REPLACEMENT THERAPY IN PEDIATRICSAKI is related with a higher morbidity and mortality rate among hospitalized children. RRT is necessary for patients with acute kidney injury (AKI) and fluid overload. Hemodynamic and thermodynamic instability may complicate the decision to initiate RRT. The decision of RRT modality is influenced by several factors that are specific to the patient and the treatment center. The use of RRT in pediatrics has not been randomized, controlled trials despite decades of use. In light of these factors, it is difficult to reach a clear consensus on RRT delivery recommendations. Children's RRT use will be summarized in this paper. Following a discussion of main treatment modalities and their data-driven specifics, RRT controversies are addressed. AKI or multiorgan disease do not have a standard of care, which necessitates prospective studies of RRTMadhankumar@gmail.comResearch922019Acute Kidney Injury,Multiorgan disease,Morbidity,MortalityMadhankumar MAssistant Professor, Department of Pediatrics, Aarupadai Veendu Medical College and Hospital, Kirumampakkam, Pondicherry - 607402