To the Editor.
—Two articles in JAMA would have untutored readers believe that the low functional status and high death rate occurring in elderly dialysis patients resulted solely from dialysis treatment.1,2 Those more knowledgeable will note instead the absence of data on other factors that could have led to the same result. The authors may be reporting things as they appear to be but not as they can or should be.Readers are given no indication of the level of dialysis efficiency provided for the patients studied. Underdialyzed patients are chronically uremic; complications of uremia include weakness and premature death. It is striking that the authors, reviewers, and editors have overlooked the need to report on the adequacy of the dialysis treatments, especially since evidence is available that a majority of hemodialysis patients in the United States have been receiving less than minimal treatment and may be dying as
Lundin AP. Outcomes of Older Patients Receiving Chronic Dialysis. JAMA. 1994;272(4):275. doi:10.1001/jama.1994.03520040034032