This study aims to determine the effect of moral distress severity on training program drop-out tendencies among adult nephrology fellows-in-training in the Philippines. This cross-sectional study utilized a validated survey questionnaire (Moral Distress Scale - Revised) to determine the frequency and severity of moral distress among adult nephrology fellows in the Philippines. We sent the survey to all PSN-accredited training institutions throughout the country. Using a 5-point (0–4) scale, fellows rated both the frequency and severity of commonly encountered workplace scenarios. The MDS-R total composite score was calculated and was further categorized into a binary variable using the cut-off 100. The survey was answered by a total of 135 Adult Nephrology Filipino Fellows-in-training. The domain that had the strongest relationship with moral distress was institutional/fellowship culture, particularly, carrying a high patient census (60% reported to experience it frequently to very frequently while 76.3% answered it to be disturbing to extremely disturbing). Using the cut-off of 100, 107 (79.3%) had at most 100 points or non-severe moral distress, meaning 20.7% can be considered as those with severe moral distress. More than half (53.3%) of the sample reported that “No”, they have never considered quitting nor had left any fellowship training program. When asked about their present status, 87.4% reported that they are not considering leaving their position now. Those who consider quitting have a higher proportion of those with severe moral distress as compared to the no drop-out tendency (35.3% vs 18.6%). However, there was no sufficient evidence to ascertain this association (p=0.098). Majority (79.3%) of participants reported non-severe moral distress and suggests that while many cope with the pressures of their roles, a substantial minority (20.7%) experience severe moral distress, indicating a need for intervention, support and retention strategies.