| Summary: | Treatment of end-stage kidney disease is a major economic challenge and public 26 health concern internationally. Decision-making related to renal replacement 27 therapy poses several practical and ethical dilemmas of global relevance for 28 patients, clinicians and policy makers. They include promoting patients’ best 29 interests, increasing access to dialysis while maintaining procedural and 30 distributive justice, minimizing the influence of financial incentives and conflicts 31 of interests, ensuring quality of care in service delivery and access to non-dialytic 32 supportive care when needed, minimizing the financial burden on patients and 33 healthcare system, and protecting the interests of vulnerable groups during 34 crisis situations. These issues have received comparatively little attention, and 35 limited ethical analysis and guidance is available to decision-makers. This paper 36 provides an overview of the major ethical issues currently related to dialysis 37 provision across the world, identifying priorities for further investigation and 38 management, and presents preliminary recommendations to guide current 39 practice and policy.
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