To the Editor.
—Dr Ifudu and colleagues1 have highlighted important issues regarding outcomes of patients receiving chronic dialysis in the United States. Especially important, as Drs Blagg and Fitts2 note in their Editorial, is the need (1) to measure and monitor patients' physical functional status and (2) to address, from the outset of treatment, contributors to patients' deconditioning and inactivity.Useful measures of functioning and well-being in ESRD patients are being developed and evaluated.3 Ifudu et al based a large part of their discussion of functional status on data obtained with a modified Karnofsky scale, which they propose as a tool that elicits more precise information than the original scale. However, it is unclear what criteria governed the specific scores that patients received on this scale. In addition, patients were asked to describe their status on the modified scale as of 2 years before starting treatment, but
Kutner NG. Outcomes of Older Patients Receiving Chronic Dialysis. JAMA. 1994;272(4):274–275. doi:10.1001/jama.1994.03520040034031
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