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The effect of artificially sweetened soft drinks/colas on kidney and cardiovascular function: Are diet sodas as harmless as they appear?

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Most of us, even the fitness freaks, feel good about consuming diet soda...that harmless, calorie-free, sugar-free indulgence. What could ever be wrong about a can of zero calorie, carbonated, flavored water?! Possibly a lot, it seems. The potential for harm stems from the various ingredients that go in to conjuring your favorite diet soft drink. Lets break down a typical artificially sweetened beverage (diet soda) in to its bare ingredients that are pertinent for this discussion : artificial sweeteners, caffeine, caramel color, and phosphoric acid.

I do not want dialysis: how long can I expect to live, and how would I feel?

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I often see patients in my office who refuse dialysis (should it become necessary) for their advancing kidney disease. I divide these patients in to two categories. The more common category is patients who refuse it because of the "fear of dialysis". They could have trouble understanding dialysis and what potential benefits they could derive from it. They would often make good dialysis candidates who have more to lose than gain by refusing dialysis therapies. The other category is the patient who rightfully refuses dialysis because she or he would not make a good candidate for such treatment. There could be multiple reasons for that. It could be advanced age and frailty, presence of other severe disease conditions like heart failure or metastatic cancer, etc. In such cases, it is hard to always predict if dialysis would add anything to the quality/quantity of life. And often, patients are simply looking at the "big picture". So the questions that come up in