In Reply: Many of these comments focus on other
factors that could confound the apparent time-of-day phenomenon that we described.
Dr Oserman suggests that patients often are assigned the afternoon slots in
maintenance dialysis because the preferred morning slots are filled. In our
data, however, there were no differences by patient shift in months on hemodialysis
before study entry, nor were there differences in comorbid diseases, such
as cardiovascular disease or diabetes, or functional status, as would be expected
given the coveted nature of the morning shift for healthier patients, as described
by Dr Watnick. Additionally, preference for morning shift because of employment
was not an issue for the majority of this population; they were elderly and
most were retired.
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