Acute renal failure in children requiring dialysis can be managed with a variety of modalities, including peritoneal dialysis, intermittent hemodialysis, and continuous hemofiltration or hemodiafiltration. The choice of dialysis modality to be used in managing a specific patient is influenced by several factors, including the goals of dialysis, the unique advantages and disadvantages of each modality, and institutional resources. This review will examine these aspects of acute renal failure management, with the goal of providing practical guidance regarding modality selection to the physician involved in the management of pediatric acute renal failure.