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July 27, 1994

Outcomes of Older Patients Receiving Chronic Dialysis-Reply

Author Affiliations

Northwest Kidney Centers Seattle, Wash

JAMA. 1994;272(4):276. doi:10.1001/jama.1994.03520040034035

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In Reply.  —In response to the letters by Dr Kutner and Dr Lundin, both of these letters support the concern we expressed in our Editorial about the interpretation of the results in the articles by Dr Ifudu and colleagues and Dr Byrne and colleagues. As anticipated, when the media picked up on these articles, the emphasis was, as Lundin notes, on dialysis as the cause of these patient problems.We agree with Kutner about the use of the "modified Karnofsky scale" in the articles by Ifudu et al. The Karnofsky scale is quite good and widely used, but the modifications in this article are such that it would not be useful to compare their results with those in other studies.Overall, these articles and the response to them reemphasize the need for much greater efforts in the rehabilitation of patients with ESRD and for education of the public that dialysis

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