To the Editor.
—Medicare's end-stage renal disease (ESRD) program has been subject to renewed critical interest in recent years. The effectiveness of the program has been judged largely by patient survival and less so by objective measures of quality of life such as employment status; neither of these have reached physician or societal expectations. The article by Dr Ifudu and colleagues1 describes "dismal" rehabilitation in geriatric inner-city hemodialysis patients. Despite the authors' claim to the contrary, we are concerned that this article may present a short-sighted interpretation of the data and provide ammunition for those who wish to institute age-based rationing of hemodialysis.1As determined by modified Karnofsky scores, the authors report a significant reduction in overall functional status compared with 2 years before the initiation of maintenance hemodialysis (mean, 5.3 years; up to 11 years previously). It is unclear how much of this decline in functional status
Chertow GM, Owen WF, Lazarus JM. Outcomes of Older Patients Receiving Chronic Dialysis. JAMA. 1994;272(4):274. doi:10.1001/jama.1994.03520040034030