Unperceived underdialysis.

Chronic progressive renal disease is clinically manifested by an array of neurobehavioral symptoms and somatic wasting. When pre-end-stage patients were studied using objective measures in both domains, progressive and clinically unperceived deterioration was demonstrated at and below glomerular filtration rates (GFRs) of 40 ml/min/1.73 m2 (serum creatinine levels as low as 2 mg/dl).