This Korean nationwide database study examined prosthetic valve selection in 765 hemodialysis patients undergoing first-time valve replacement between 2003 and 2018. Using inverse probability treatment weighting to adjust for baseline differences between bioprosthetic (BP, n=421) and mechanical (MP, n=344) valve recipients, the authors found comparable early outcomes and late mortality between groups across all age subgroups (<50, 50-64, ≥65 years). While BP was associated with higher rates of redo aortic valve replacement, MP showed significantly increased major bleeding complications. Notably, median survival was markedly reduced at 6.6, 4.0, and 2.1 years for patients aged <50, 50-64, and ≥65 years respectively. The authors concluded that, given the considerably shortened lifespan in this population, bioprosthetic valves represent a reasonable option even for younger hemodialysis patients, except those with hypercalcemia or potential kidney transplant candidacy.