This article provides the pediatric clinician with brief discussions and summaries of the various commonly used, and published, anticoagulation agents and strategies currently used by centers offering renal replacement therapy to children and adults. Pediatric data and references are provided when they exist; adult literature is reviewed and summarized when and where pediatric data are lacking. The coagulation system in general, its alterations in the face of the “uremic milieu”, and the biologic effects of the extracorporeal system (namely dialyzer membranes and tubing) on the coagulation cascade are reviewed. Anticoagulation strategies for continuous and intermittent hemodialytic methods and peritoneal dialysis are reviewed, followed by a discussion of patients at elevated risk of bleeding and heparin induced thrombocytopenia. The doses and protocols are reviewed and presented here as they have been previously published in journals or textbooks; however, every patient and clinical situation is unique and any decision to make use of the strategies outlined in this paper should be made by the treating physician with careful consideration of the individual patient risk and benefit.