<p>Paediatric dialysis services have been available in Nepal for three decades but are limited to a few tertiary referral centres in major cities. The availability of a small number of paediatric nephrologists, an increasing number of adult nephrologists, and a modest increase in dialysis facilities have contributed to the gradual expansion of paediatric nephrology and kidney replacement therapy services in Nepal over the last decade. These services have grown steadily and will continue to grow because of the positive impact of government support for kidney replacement therapy and various public health initiatives to promote kidney health. Several challenges, such as the inaccessibility of healthcare, shortage of healthcare professionals, and scarcity of dialysis equipment, remain to be overcome to improve the delivery and effectiveness of kidney replacement therapy services for better health outcomes in paediatric kidney disease. This article discusses the history of paediatric dialysis, the current situation, and strategies to improve the availability of kidney replacement therapy for Nepalese children.</p> Graphical abstract <p></p>