Dialysis practices in pediatric patients differ from those in adults due to physiological maturation differences and developmental requirements. The need for dialysis most commonly arises as a result of acute kidney injury, advanced stages of chronic kidney disease, and metabolic or hemodynamic disorders developing in intensive care settings. Refractory hyperkalemia, severe metabolic acidosis, fluid overload, and uremic symptoms are the primary indications in the acute phase, while symptomatic uremia and growth retardation are the determining criteria in chronic kidney disease. The choice of modality is individualized according to the patient's hemodynamic stability, age, and clinical priorities. The primary goal of pediatric dialysis is not only to achieve metabolic balance but also to ensure the preservation of growth, development, and long-term quality of life.