Abstract
BackgroundWhen treating patients with kidney failure, unavoidable ethical issues often arise. Current clinical practice guidelines some of them, but lack comprehensive information about the full range of relevant ethical issues in kidney failure. A systematic literature review of such ethical issues supports medical professionalism in nephrology, and offers a solid evidential base for efforts that aim to improve ethical conduct in health care.AimTo identify the full spectrum of clinical ethical issues that can arise for patients with kidney failure in a systematic and transparent manner.MethodA systematic review in Medline (publications in English or German between 2000 and 2014) and Google Books (with no restrictions) was conducted. Ethical issues were identified by qualitative text analysis and normative analysis.ResultsThe literature review retrieved 106 references that together mentioned 27 ethical issues in clinical care of kidney failure. This set of ethical issues was structured into a matrix consisting of seven major categories and further first and second-order categories.ConclusionsThe systematically-derived matrix helps raise awareness and understanding of the complexity of ethical issues in kidney failure. It can be used to identify ethical issues that should be addressed in specific training programs for clinicians, clinical practice guidelines, or other types of policies dealing with kidney failure.
Highlights
Chronic kidney failure is the gradual loss of kidney function
It can be used to identify ethical issues that should be addressed in specific training programs for clinicians, clinical practice guidelines, or other types of policies dealing with kidney failure
Further ethical issues might come with heterogeneities of referral criteria for transplantation or financial conflicts of interest that could intervene in a sound inter-professional management of patients with chronic kidney failure
Summary
It can progress to end-stage kidney failure, which is fatal without artificial filtering (dialysis) or a kidney transplant. The care of patients with kidney failure involves diverse ethical challenges. Many patients with chronic kidney failure need to decide whether to begin or stop dialysis therapy. Dialysis may offer considerable benefits (e.g., be life sustaining), and entails major burdens (e.g., is very restrictive and time consuming). Balancing these benefits and side-effects for different stages of the disease involve complex value judgments. Further ethical issues might come with heterogeneities of referral criteria for transplantation or financial conflicts of interest that could intervene in a sound inter-professional management of patients with chronic kidney failure. A systematic literature review of such ethical issues supports medical professionalism in nephrology, and offers a solid evidential base for efforts that aim to improve ethical conduct in health care
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