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—Dr Lundin notes that our study fails to report or control for the adequacy of dialysis in our study population and that underdialysis may be responsible for the low survival rates in elderly dialysis patients. We agree that adequacy of and compliance with dialysis are two important determinants of survival, and we have noted in our study that because of the lack of these and other data, we were unable to explain survival patterns. However, we are unaware of any studies that suggest that underdialysis is more prevalent in the elderly and that improving dialysis will significantly raise their survival rates. The data clearly show that the difference in survival between ESRD patients and their age-matched peers increases with age, suggesting that even with adequate dialysis, elderly ESRD patients will have poor survival because of coexistent medical conditions and cumulative frailties.Age and cause of renal failure are
Byrne C, Vernon P, Cohen JJ. Outcomes of Older Patients Receiving Chronic Dialysis-Reply. JAMA. 1994;272(4):276. doi:10.1001/jama.1994.03520040034034