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Recent trends toward early initiation of hemodialysis (HD) — at estimated glomerular filtration rates (eGFRs) >10 mL/minute/1.73 m2 — have been driven by expectations that it would lower early morbidity and mortality in patients with end-stage renal disease (ESRD). Because prior studies were criticized for not controlling for comorbidity, researchers based this study on a U.S. ESRD database of 81,000 HD patients (age range, 20–64) without substantial comorbidities other than hypertension; survival was assessed specifically among the 36,000 “healthiest” patients (those with serum albumin levels ≥3.5 g/dL).
In analyses adjusted for several clinical and demographic factors in the healthy cohort, death by 1 year was more common among patients wh…