We welcome the contribution of Bahrainwala et al1 in highlighting the perioperative care of patients receiving long-term dialysis. Consistent with previous studies, the authors quote a 10-fold higher relative risk for in-hospital mortality for patients receiving maintenance dialysis undergoing elective surgery compared with those without chronic kidney disease (CKD).2 However, we believe that using relative risk estimates with patients without CKD as a benchmark for comparison provides an inflated perception of perioperative mortality.