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Editor's Correspondence
Health Care Reform
March 14, 2011

Survivor Bias in Early- vs Late-Start Hemodialysis Studies—Reply

Author Affiliations

Author Affiliations: Dorn Research Institute, Wm. Jennings Bryan Dorn Veterans Hospital, Columbia, South Carolina (Drs Rosansky); Arnold School of Public Health, University of South Carolina, Columbia (Dr Rosansky and Mr Jackson); National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland (Dr Eggers); Geffen School of Medicine at University of California, Los Angeles (Dr Glassock); and Division of Nephrology, London Health Sciences Centre, London, Ontario, Canada (Dr Clark).

Arch Intern Med. 2011;171(5):477-478. doi:10.1001/archinternmed.2011.66

In reply

We agree that survivor bias, sometimes referred to as survival of the fittest, is a possible problem in an observational study of the association between initial eGFR at dialysis initiation and survival. As suggested by Dr Pickering, survivor bias might be reduced by calculating survival time from a common eGFR starting point rather than from the time of initiation of dialysis, but this is not possible given that many patients initiate dialysis before researching the “common” eGFR point.