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March 13, 2002

Does Time of Day of Hemodialysis Affect Survival?

JAMA. 2002;287(10):1262-1264. doi:10-1001/pubs.JAMA-ISSN-0098-7484-287-10-jlt0313

To the Editor: Dr Bliwise and colleagues1 found that patients who received dialysis in the morning had lower mortality rates than those who received dialysis in the afternoon. My clinical experiences suggest an explanation. I have noticed that dialysis times are not assigned randomly. Priority assignment for morning dialysis often goes to patients who can return to their previous employment. Bliwise et al, however, do not provide occupational histories for these patients. Perhaps patients who cannot return to work are sicker and therefore have decreased survival. Also, patients most recently starting maintenance hemodialysis frequently are assigned to the afternoon or evening dialysis slots because there may not be available times in the morning period. Recent onset of hemodialysis may be a marker for patients who were recently hospitalized and have comorbid conditions that independently increase the risk of mortality.