Extracorporeal membrane oxygenation (ECMO) represents a lifesaving therapy utilized in in the most critically ill neonates and children with reversible cardiopulmonary failure. As a result of the severity of their critical illness these patients are among the highest risk populations for developing acute kidney injury (AKI) and disorders of fluid balance including the pathologic state of fluid overload (FO). In multiple studies AKI has been shown to occur commonly in 60-80% children treated with ECMO and is associated with adverse outcomes. In early studies evaluating ECMO in neonatal respiratory populations, the importance of fluid balance and the development of FO was recognized as an important contributor to adverse outcomes. Multiple single center studies and multicenter work have confirmed that FO occurs commonly across ECMO populations and is consistently associated with adverse outcomes. As a result of the high rates of AKI and the high rates of FO, continuous renal replacement therapy (CRRT) is increasingly utilized in neonatal and pediatric ECMO. In this state-of-the-art review, we cover the definitions, pathophysiology, incidence, and impact of AKI and FO in neonates and children supported with ECMO and summarize and appraise the evidence regarding the use of CRRT concurrently with ECMO. This review will cover the appropriate timing of this initiation, the options for providing CRRT with ECMO, overview of CRRT prescription, and the long-term implications of kidney support therapy in this population.

体外膜肺氧合 (ECMO) 是一种挽救生命的疗法，适用于病情最危重的新生儿和患有可逆性心肺衰竭的儿童。由于病情严重，这些患者属于发生急性肾损伤 (AKI) 和液体平衡紊乱（包括液体超负荷 (FO) 病理状态）的最高风险人群。多项研究表明，60-80% 接受 ECMO 治疗的儿童通常会发生 AKI，并且与不良后果相关。在评估新生儿呼吸系统 ECMO 的早期研究中，液体平衡的重要性和 FO 的发展被认为是不良后果的重要影响因素。多项单中心研究和多中心工作已证实 FO 在 ECMO 人群中普遍发生，并且始终与不良后果相关。由于 AKI 发生率高和 FO 发生率高，连续肾脏替代疗法 (CRRT) 越来越多地应用于新生儿和儿科 ECMO。在这篇最先进的综述中，我们涵盖了 AKI 和 FO 对 ECMO 支持的新生儿和儿童的定义、病理生理学、发病率和影响，并总结和评估了与 ECMO 同时使用 CRRT 的证据。本综述将涵盖启动此治疗的适当时机、提供 CRRT 和 ECMO 的选择、CRRT 处方概述以及肾脏支持治疗对该人群的长期影响。