To the Editor.
—Ms Byrne and colleagues1 present 1-, 3-, and 5-year survival rates for patients in the United States beginning dialysis at 55 years of age or older, by age and cause of ESRD (primary diagnosis) at initiation of dialysis. They state that their data "should prove useful to those... making clinical decisions about the appropriateness of initiating chronic dialysis in older patients."The authors imply that dialysis might not be offered to patients in particular age groups and primary diagnosis groups, such as older patients with diabetes as the cause of ESRD. They acknowledge that additional factors are likely related to survival, eg, comorbidities, nutritional status, compliance with treatment, and adequacy of dialysis, but they do recommend that analyses based on age and primary diagnosis may be used to make decisions regarding rationing of dialysis.Following the authors' recommendations would differentially affect rationing dialysis for older blacks,
Brogan DJ. Outcomes of Older Patients Receiving Chronic Dialysis. JAMA. 1994;272(4):275-276. doi:10.1001/jama.1994.03520040034033