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To the Editor: We are concerned that the sample of Dr Liu and colleagues¹ may not be representative of US patients who receive dialysis. The median age of patients receiving incident dialysis in the United States is 64.5 years,² whereas in the study by Liu et al it was 57.2 years for all patients and 53.7 years for those without malnutrition-inflammation complex syndrome (MICS). The renal transplant rate in the US dialysis population is approximately 5.5 per 100 patient-years.² One would thus expect 103 in the cohort of Liu et al, but this is substantially fewer than the 153 the authors reported. Hence, the younger age and the higher transplant rate in this study indicate a dialysis population that is substantially healthier than average.

The authors stated that their findings support aggressive treatment of hypercholesterolemia in patients receiving dialysis. We disagree with this conclusion, as the authors' own analyses in . . . [Full Text of this Article]

Kamyar Kalantar-Zadeh, MD, PhD, MPH
kamkal@ucla.edu
Harbor-UCLA Medical Center Heart and Lung Institute
Torrance, Calif

Stefan D. Anker, MD, PhD
Imperial College
London, England

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