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One of the potential reasons of cardiovascular events and death in people with end-stage renal illness has been suggested: chronic activation of the mineralocorticoid receptor. The goal of this observational cohort study was to show that serum cortisol could be a predictor of patient death and to look at its relationship with oxidized low-density lipoprotein (ox LDL) in HD patients. Two institutions screened patients who received HD three times a week for enrollment. Before each HD session, baseline cortisol levels were assessed, and the patients were placed into two groups based on the median serum cortisol value. In patients receiving HD, serum cortisol is a useful predictor of all-cause death. In HD patients, Ox LDL is an independent marker for high serum cortisol.