Menon S, Broderick J, Munshi R, et al. - Researchers describe demographics, circuit features, complications, and short- and long-term consequences among children who received kidney replacement therapy (KRT) with an ultrafiltration device (n = 119 admissions, 884 circuits) in this multicenter, retrospective case series, for the first time ever. For fluid elimination in adults with diuretic resistant heart failure, an ultrafiltration device known as the Aquadex FlexFlow System (CHF Solutions Inc., Eden Prairie, MN) has been designed, with an extracorporeal volume of 33 ml. Either slow continuous ultrafiltration, or continuous venovenous hemofiltration, or prolonged intermittent KRT was received by the patients. Survival to end of KRT was the primary outcome. Lower KRT survival was reported in patients weighing < 10 kg vs those > 20 kg. More volume overload at onset and receipt of KRT for a longer duration were also noted in patients < 10 kg. The use of this device allowed KRT initiation with minimal complications, especially in critically ill neonates. An unmet requirement for devices specially designed for younger patients was realized. In order to provide improved care to smaller children who need kidney support, size-appropriate machines are required.