In light of the recent trend toward earlier dialysis initiation and its association with mortality among patients with end-stage renal disease, Bao et al hypothesized that frailty is associated with higher estimated glomerular filtration rate at dialysis start and may confound the relation between earlier dialysis initiation and mortality. The authors examined frailty among participants of the Comprehensive Dialysis Study. Among 1576 incident dialysis participants included, the prevalence of frailty was 73%. In multivariable analysis, higher eGFR at dialysis initiation was associated with a 44% higher odds of frailty. Frailty was independently associated with mortality (hazard ratio [HR], 1.57 [95% CI, 1.25 to 1.97]; P < .001) and time to first hospitalization (HR, 1.26 [95% CI, 1.09-1.45]; P < .001). While higher eGFR at dialysis initiation was associated with mortality (HR, 1.12 [95% CI, 1.02-1.23] per 5 mL/min/1.73m2; P = .02), the association was no longer statistically significant after frailty was accounted for (HR, 1.08 [95% CI, 0.98-1.19] per 5 mL/min/1.73m2; P = .11). The study findings suggest that the decision of early dialysis initiation should be considered carefully, since the results do not prove any benefits of early start regardless of baseline frailty status.