Recently some publications have assessed the quality of life in predialysis patients. Unfortunately, none has yet assessed the quality of life in predialysis patients on different regimens. Several publications also purport to document the "usual" biochemical abnormalities seen in predialysis patients. Again, the authors seem to forget that the results reflect the quality of care that has been provided more than the fundamental characteristics of the predialysis state.
A striking example is a series of measurements from Sweden by Sten-vinkel, Heimburger, and colleagues. Their patients were assessed just before they started on dialysis, apparently never having been seen before by the investigators. At least, I hope this is the case, since the patients were clearly neglected, presumably by their physicians. Not only did they have low albumin levels, indicating malnutrition, but their bicarbonate levels were not even measured. We can assume, therefore, that acidosis (low bicarbonate level) was very common and often severe, as documented by Raymond Hakim and Michael Lazarus, who reported serum bicarbonate levels in 911 predialysis patients at Harvard. Good predialysis care can almost totally prevent low serum albumin or bicarbonate levels.
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