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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: Several methodological problems could have influenced the outcome of the study by Dr Bliwise and colleagues.1 First, since this was not a randomized study, selection bias is an important consideration. Factors that determine dialysis time have an unknown effect on survival, including patient shift preference and shift availability. Moreover, treatment time was recorded only twice, 1988 and 1991. Twenty-four patients were excluded because their shift changed between 1988 and 1991. Additional determinations of dialysis time during the last 8 years of the study would likely have excluded additional subjects.