RENAL REPLACEMENT THERAPY. ETHICAL ISSUES
Hassan Alwaali, Pytetska Natalya

Although dialysis and renal transplantation successfully treat patients with end-stage renal disease, there are patients who have additional clinical characteristics that draw the appropriateness or continuation of such therapy into question. Not every patient, for example, benefits from renal replacement therapy to the same degree.
	The universal availability of renal replacement therapy in the United States forces 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. 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.
	Ethical issues relating to renal replacement therapy are drawing increasing attention within the nephrology community. As an example, one prominent nephrologist has written that the current renal replacement practices in the United States have resulted in "legions of zombies" on chronic dialysis. Many additional nephrologists in the United States, Canada, and abroad have questioned why the prevalence of renal replacement therapy is so much higher in the United States when compared with other countries. This higher rate is due to a number of factors, including:
– the patient is in part in control of his/her medical destiny;
–the patient often has limited knowledge and understanding of his/her renal and medical disorders.