The Time to Reduce Mortality in ESRD (TiME) trial was a large pragmatic trial demonstration project designed to determine the benefits of hemodialysis sessions that are longer than many patients currently receive. The trial was conducted through a partnership between academic investigators and 2 large dialysis provider organizations using a highly centralized implementation approach. Although the trial accomplished most of its demonstration project objectives, uptake of the intervention was insufficient to determine whether longer sessions improve outcomes.