Examining Renal Concerns in Ethics Consults

ABSTRACT

Background: Few published studies focus on the effects of collaboration between nephrology and ethics. It is widely accepted by nephrologists that there are ethical concerns which arise in daily practice. In addition to the impact on the individual, societal concerns include equitable access to care for kidney disease. The American Society of Nephrology, with the European Renal Association-European Dialysis and Transplant Association and International Society of Nephrology Joint Working Group released ten topics, which should serve as an ethical priority (2020). These include Equity in access to integrated kidney failure care;Setting priorities in kidney disease prevention and care;Supporting shared decision making about kidney failure care;Avoiding futile or overly burdensome dialysis treatment;Reducing the cost of dialysis care without compromising quality;Preventing organ trafficking and transplant tourism;Evaluating the risks and outcomes of living kidney donation;Addressing the ethical implications of genetic kidney disease;Managing conflicts of interest in nephrology;Advocating responsibly for kidney health. Yet, there is no clear guidance on how to manage these concerns. Additionally, training does not focus on this in a standardized manner. This pilot study sought to describe the ethical framework necessary towards improving overall outcomes. Method(s) IRB approval was obtained to perform a retrospective chart review of bioethics consults for renal patients treated in a tertiary medical system in New York State. This included pediatric and adult patients. The authors reviewed the consults. Reasons for consult were extracted and categorized based on the priorities set forth in 2020. This included organ transplantation;genetic kidney disease;avoidance of futile/ overly burdensome dialysis;shared decision- making. Result(s) Population-level concerns did not emerge in consults. More than one reason for consult could be identified, as well as a "none of the above" category. Continued analysis is on-going. Conclusion(s) It is likely that the concurrent COVID-19 global pandemic and its effect on renal health and resource allotment heavily impacted these results. However, it is apparent that there is a large focus on the burden of dialysis, suggesting that these should be more clear approaches to these concerns, used by practicing nephrologists. Additional studies are required to further evaluate this initiative.