In an interesting article regarding patient-reported outcomes (PROs) in patients receiving hemodialysis (HD), Anderson et al1 stated that cognitive impairment may influence PRO results. We believe that this brief recognition needs more expansion. Research suggests that approximately one-third of patients receiving HD have dementia,2,3 with a greater prevalence in those of older age and with severe somatic conditions.4,5 Dementia, by definition and depending on the disease’s stage, is associated with difficulties in activities of daily living, such as inability to prepare or consume meals, forgetting about past or planned actions and events, inability to manage one’s medications, and troubles understanding verbal communications and other cues.