Dialysis decision-making among hospitalized patients often raises ethical challenges related to decisional capacity, treatment refusal, and non-beneficial treatment. 1 These dilemmas are frequently compounded by absence of advance care planning (ACP), 2 urgent dialysis initiation, potential for burden relative to benefit at the end of life,3 and limited experience with shared decision-making and serious illness prognostication and communication. 4 Clinical ethics consultations (CECs) can support clinicians navigating these decisions, yet the contexts, recommendations, and outcomes of dialysis-related CECs remain under-characterized.