Mina D, et al. - A total of 140,899 Medicare-covered adults who had hemodialysis in 2011, were assessed by the investigators to estimate the prevalence, clinical indications, and adverse consequences of muscle relaxant use in hemodialysis patients in this observational cohort study. They categorized time to first emergency department visit or hospitalization for altered mental status, fall, or fracture as primary outcomes; death and composites of death with each of the primary outcomes were secondary outcomes. They observed that muscle relaxant use was linked to a greater risk for altered mental state and fall vs no use. They observed that 11%, 6%, 3%, and 13% of patients had an incident of altered mental status, fall, fracture, and death, respectively. The lower prevalence of death with muscle relaxants could result from the effect of residual confounding.