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Ethical issues in the care of the patient with end-stage renal disease

Holly M Koncicki, MD
Lionel U Mailloux, MD, FACP
Section Editors
Steve J Schwab, MD
R Sean Morrison, MD
Deputy Editor
Alice M Sheridan, MD


Although dialysis successfully treats patients with end-stage renal disease (ESRD), there are patients who have additional clinical characteristics that draw into question the appropriateness or continuation of such therapy. Not every patient benefits from renal replacement therapy to the same degree.

The universal availability of dialysis in the United States allows the nephrologist to consider its application in every patient in whom it might be indicated. In this setting, each patient and clinical setting must be judged individually [1]. As an example, the issues and concerns surrounding a 45-year-old patient with adult polycystic kidney disease are entirely different from those of a 90 year old with severe arteriosclerosis.

The general ethical issues surrounding the dialytic or conservative care of patients with ESRD are presented in this topic review. Issues regarding kidney transplantation are discussed elsewhere. (See "Evaluation of the potential renal transplant recipient".)

Practical considerations regarding the decision to forego dialysis and the ongoing medical care of patients who forego dialysis are discussed separately. (See "Withdrawal from and withholding of dialysis" and "Conservative care of end-stage renal disease".)


Decisions involving the initiation or maintenance of dialysis, particularly among patients who are suboptimal candidates for chronic dialysis therapy, involve several ethical principles, collectively called principalism [2]. (See "Ethical issues in palliative care", section on 'Applying principlism in palliative care'.)

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Literature review current through: Nov 2017. | This topic last updated: May 18, 2016.
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