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Uncovering real mortality trends in ESRD patients. Major temporal changes in the case mix of patients accepted for renal replacement therapy impede analysis of long-term mortality trends in end-stage renal disease patients. A record linkage study of 2 large electronic hospital inpatient data sets with national mortality data used standardization by age, sex, and comorbidity to uncover a 50% decline in 3-year mortality in English patients starting renal replacement therapy between 1970 and 2008, a faster drop than that seen in the general population.