In remote Indigenous communities, people with end stage kidney disease have limited access to dialysis services and the vast majority of patients contend with urban displacement in order to access treatment. Through ethnographic encounters with Yolŋu renal patients and other actors in Northern Territory healthcare systems, this paper explores how the threats posed by end stage kidney disease are multiply conceptualised and imbued with different forms of moral and political value. Drawing on Mary Douglas’ cultural theory of risk, I consider how Yolŋu, health professionals and health policymakers construct topographies of safety and danger. I argue that medical risk is deployed in Northern Territory healthcare systems to perform the ‘dirty work’ of governing uncertainties and threats to renal patients’ health and of distributing treatment amongst patients and over space. The ‘dirty work’ of medical risk recasts questions of value and the distribution of resources into matters of safety and liability.