Seminars in Dialysis. 2020;00:1–11. wileyonlinelibrary.com/journal/sdi | 1 © 2020 Wiley Periodicals, Inc. 1 | INTRODUCTION Chronic kidney disease (CKD) and end-stage renal disease (ESRD) in the pediatric population are widely prevalent and are associated with devastating consequences. The most recent annual report of the United States Renal Data System (USRDS) reported an ESRD point prevalence of 99.1 per million in children and adolescents. 1 Over the past few decades, tremendous advances have been made toward the management of CKD and ESRD in children to prevent the associated morbidity and mortality. A vital role in these advances is of renal replacement therapies (RRT). The introduction of dialysis and eventually renal transplant has greatly impacted the quality of life and survival in patients with ESRD. In 2016, 702 pediatric ESRD patients (51.2%) commenced treatment with hemodialysis (HD), 353 (25.7%) with (peritoneal dialysis) PD, and 275 (20.0%) received renal transplants (Figure 1). 1 The number of children who were waitlisted for a renal transplant in 2016 was 1,119 and the median waiting time for the first transplant was 12.94 months. 1 The median first trans- plant time may be even longer in patients with immunological sensi- tization and other comorbid conditions. Despite paramount success with renal transplant, a considerable number of patients continue to be dependent on dialysis modalities in the interim period as the mainstay of treatment. Once a decision to start dialysis has been made, another im- portant decision is to choose the best dialysis modality for the patient to provide optimum dialysis. The concept of optimum dial- ysis is tricky as the perception of optimum dialysis is different for children and parents as compared with the nephrologist. Children and parents want a dialysis modality that would take as little of their time as possible, be painless and would still allow the child to Received: 23 October 2019 | Revised: 8 February 2020 | Accepted: 18 February 2020 DOI: 10.1111/sdi.12863 REVIEW ARTICLE Nocturnal home hemodialysis in children: Advantages, implementation, and barriers Manpreet K. Grewal 1 | Arul Mehta 2 | Ronith Chakraborty 3 | Rupesh Raina 3,4 1 Department of Pediatric Nephrology, Children's Hospital of Michigan, Detroit, MI, USA 2 Saint Ignatius High School, Cleveland, OH, USA 3 Akron Nephrology Associates/Cleveland Clinic Akron General, Akron, OH, USA 4 Department of Nephrology, Akron Children's Hospital, Akron, OH, USA Correspondence Rupesh Raina, Department of Nephrology, Cleveland Clinic Akron General and Akron Children's Hospital, Akron, OH, USA. Email: rraina@akronchildrens.org; raina@ akronnephrology.com Abstract Chronic kidney disease and end-stage renal disease (ESRD) in children are major health concerns worldwide with increasing incidence and prevalence. Renal replace- ment therapies and kidney transplants have remarkably improved the management of patients with ESRD in both adult and pediatric populations. Kidney transplant has the best patient outcomes, but many a time it has a considerable waiting period. In the meantime, the majority of patients with pediatric ESRD are dependent on di- alysis. The conventionally utilized hemodialysis regimen is the three times weekly, in-center hemodialysis. Many studies have demonstrated the unfavorable long-term morbidity associated with the conventional regimen. Intensified dialysis programs, which include extended nocturnal hemodialysis or short daily hemodialysis, are being increasingly advocated over the past two decades. In addition to having much bet- ter clinical outcomes as compared with the conventional regimen, the flexibility to provide dialysis at home serves as a great incentive. PubMed/Medline, Embase and Cochrane databases for literature on nocturnal home hemodialysis in children with ESRD were extensively searched. Contrary to the noticeable literature available on adult home hemodialysis, a small number of studies exist in the pediatric popula- tion. In this review, the benefits, implementation and associated barriers of nocturnal home hemodialysis in children were addressed.