In their study based on data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) census database, including 86,886 hemodialysis patients from 11 countries, Robinson and colleagues show that in all countries studied, mortality is higher in the first 120 days after the start of dialysis than after this period. We discuss factors that may affect international differences in early mortality, including current dialysis initiation practices and withdrawal from dialysis.