Ethical, legal and cultural implications in the management of chronic kidney disease (CKD) patients: a critical review of literature

Abstract

The objective of this review was to highlight the ethical, legal and cultural implications in the management of chronic kidney disease (CKD) patients.Articles were identified from online databases, namely Medline, PubMed, google scholar and grey literature. A comprehensive search was done to identify articles which highlight the cultural, ethical and legal implications regarding the management of CKD patients and 42 of them were identified.Autonomy and justice were the two main ethical principles identified and their conflicting issues with regards to renal replacement therapy (RRT). Supply and demand with kidney donation and transplantation has led to numerous ethical and moral issues among CKD patients. Although there have been developments in the legal and ethical frameworks to follow, RRT remains a controversial issue.The conflict between justice and autonomy is critical to analyse when looking at the existence of RRT for CKD patients around the world. Conflicting ethical principles could be considered to cause more harm to patients than benefits (maleficence versus beneficence) and, consequently, limited patient engagement resulting in non-adherence to management among CKD patients.