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Bring a large pot of salted water to a boil. Cook the ditalini until al dente. Reserve 1 cup of pasta water, then drain and set pasta aside.
In a large skillet over medium-high heat, cook the sliced kielbasa until browned and slightly crispy. Do not drain the pan.
Reduce heat to medium and remove kielbasa. Add butter to the kielbasa pan and let it melt.
Add cream cheese and stir until softened and melty.
Sprinkle in Cajun seasoning, garlic powder, onion powder, Italian seasoning, salt, and pepper. Season generously.
Slowly pour in the reserved pasta water, stirring constantly, until a creamy sauce forms.
Add drained pasta directly into the skillet and toss to coat.
Stir in Parmesan cheese until melted and creamy.
Add the kielbasa back in (if removed), toss everything together, taste, and adjust seasoning as needed.
Serve hot with extra Parmesan on top.