The application of competing risk analysis techniques strengthen the conclusions of this study. While it is indisputable that, in the presence of a competing risk such as death, cumulative incidence curves are the method of choice rather than conventional Kaplan-Meier estimates, there is some controversy as to whether the standard cause-specific Cox regression analysis or the proportional subdistribution hazards model should be used to obtain adjusted hazard ratios. We decided to use the la er because it directly models differences in cumulative incidences and permits the investigator to predict the cumulative incidence of ESRD based on the covariate values of a patient. This would not have been possible when using the cause-specific Cox model. Our competing risk analysis using the Fine-Gray model mirrors more precisely the association between a covariate and the cumulative incidence of ESRD in patients at high risk of death during the observation period. Our observation that urine osmolarity might be positively associated with the risk for ESRD is robust as regards the type of analysis used, as results of the cause-specific Cox model were very similar. In conclusion, we demonstrate that higher urine osmolarity is independently associated with a higher risk of initiating dialysis in a cohort of patients with CKD stage 1 to 4. Modifying urine osmolarity by dietary counselling or pharmaceutical interventions might evolve into a further treatment option in ESRD. The members of the Flaviviridae family are small, enveloped viruses, and include the genera Flavivirus, Pestivirus and Hepacivirus. The genus Pestivirus includes the bovine viral diarrhea virus and the classical swine fever virus, two animal pathogens responsible for economic losses in the livestock industry. Hepatitis C virus is the best studied member of the genus Hepacivirus, as HCV infection is a major cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma in humans, affecting 170 million people worldwide. Finally, the genus Flavivirus comprises more than 70 viruses, many of which are arthropodborne human pathogens causing a range of important diseases, including fevers, encephalitis and hemorrhagic fever. Flaviviruses include dengue virus, yellow fever virus, West Nile virus, Japanese encephalitis virus and tick-borne encephalitis virus. DENV merits particular a ention, because recent investigations have indicated that this virus causes an estimated 390 million new infections worldwide each year, 96 million of which are associated with subclinical or more severe clinical symptoms, from mild fever to potentially fatal dengue shock syndrome. The Flaviviridae genome is a single-stranded RNA molecule, which, upon its introduction into the host cell, is recognized as a messenger RNA and translated by the host cell machinery, to yield a polyprotein. Eleutheroside-E Processing by viral and cellular enzymes releases the individual viral gene Saikosaponin-C products. The structural proteins constituting the virion consist of a core and envelope proteins. Most of the nonstructural proteins associate to form the replicase complex, which catalyzes RNA accumulation, in close association with modified host-cell membranes. Several reports have described the intracellular morphogenesis of DENV, YFV and BVDV.