***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: Introduction : In peritoneal dialysis ( PD ) patients , volume overload is related to cardiac dysfunction and mortality , while intravascular volume depletion is associated with a rapid decline in the residual renal function ( RRF ) . This study sought to determine the clinical usefulness of bioimpedance spectroscopy (BIS)-guided fluid management for preserving RRF and cardiac function in PD patients . Subjects and methods : This is a multicenter , prospect i ve , open-label study that was conducted over a 1-year period ( NCT01887262 ) . Non-anuric ( urine volume > 500 mL/day ) subjects on PD were enrolled . Subjects in the control group received fluid management based on the clinical information alone . Those in the BIS group received BIS-guided fluid management along with clinical information . Results : The subjects ( N = 137 , mean age 51.3 ± 12.8 years , 54 % male ) were r and omly assigned to the BIS group ( n = 67 ) or to the control group ( n = 70 ) . There were no significant differences between the 2 groups with regard to age , sex ratio , cause of kidney failure , duration of PD , baseline comorbidity , RRF , PD method , or peritoneal transport type . At baseline , the 2 groups were not different in terms of RRF ( glomerular filtration rate [ GFR ] , 5.1 ± 2.9 vs 5.5 ± 3.7 mL/min/1.73 m2 ) . After follow-up , changes in the GFR between the 2 groups were not different ( -1.5 ± 2.4 vs -1.3 ± 2.6 mL/min/1.73 m2 , p = 0.593 ) . Over the 1-year study period , both groups maintained stability of various fluid status parameters . Between the 2 groups , there were no differences in the net change of various fluid status parameters such as overhydration ( OH ) and extracellular water/total body water ( ECW/TBW ) . A net change in ECW over 1 year was slightly but significantly higher in the control group ( net increase , 0.57 ± 1.27 vs 0.05 ± 1.63 L , p = 0.047 ) . However , this difference was not translated into an improvement in RRF in the BIS group . There were no differences in echocardiographic parameters or arterial stiffness at the end of follow-up . Conclusion : Routine BIS-guided fluid management in non-anuric PD patients did not provide additional benefit in volume control , RRF preservation , or cardiovascular ( CV ) parameters . However , our study can not be generalized to the whole PD population . Further research is warranted in order to investigate the sub population of PD patients who may benefit from routine BIS-guided fluid management The number of published systematic review s of studies of healthcare interventions has increased rapidly and these are used extensively for clinical and policy decisions . Systematic review s are subject to a range of biases and increasingly include non-r and omised studies of interventions . It is important that users can distinguish high quality review s. Many instruments have been design ed to evaluate different aspects of review s , but there are few comprehensive critical appraisal instruments . AMSTAR was developed to evaluate systematic review s of r and omised trials . In this paper , we report on the updating of AMSTAR and its adaptation to enable more detailed assessment of systematic review s that include r and omised or non-r and omised studies of healthcare interventions , or both . With moves to base more decisions on real world observational evidence we believe that AMSTAR 2 will assist decision makers in the identification of high quality systematic review s , including those based on non-r and omised studies of healthcare interventions Purpose Fluid management with body composition monitor based on bioimpedance spectroscopy ( BCM-BIS ) has been found to be beneficial for dialysis patients . We conducted a study to provide an algorithm for the determination of post-dialysis target weight ( PDTW ) and to evaluate whether this approach could improve clinical outcomes compared to patients who had PDTW decided clinical ly . Methods Two hundred and ninety-eight dialysis patients participated in this 1-year r and omized controlled trial . The outcomes were all-cause hospitalization rate , AFO or CV-related events , hypertension and intra-dialysis morbidities . Results 80 % of post-dialysis weight reached the target set with current algorithm . All-cause hospitalization rate was not different . Incidence of acute fluid overload ( AFO ) or CV-related events was lower in study group . Longitudinal data showed decreased incidence of hypertension , intra-dialysis morbidities and intra-dialysis hypotension . Conclusions Assessment of PDTW by BCM-BIS with an explicit algorithm decreased AFO or CV-related events , hypertension and intra-dialysis morbidities . Further studies were required to demonstrate possible benefits of hospitalization rate BACKGROUND The relationship between blood pressure ( BP ) and mortality in hemodialysis patients has remained controversial . Some studies suggested that a lower pre- or postdialysis BP was associated with excess mortality , while others showed poorer outcome in patients with uncontrolled hypertension . We conducted a multicenter prospect i ve cohort study to evaluate the impact of hemodialysis-associated hypotension on mortality . METHODS We recruited 1244 patients ( 685 males ; mean age , 60 + /- 13 years ) who underwent hemodialysis in 28 units during the two-year study period beginning in December 1999 .  Pre- , intra- , and postdialysis BP , and BP upon st and ing soon after hemodialysis , were measured in all patients at entry . Logistic regression analysis was used to assess the effect on mortality of pre- , intra- , and postdialysis BP , a fall in BP during hemodialysis  , and a fall in BP upon st and ing soon after hemodialysis .  RESULTS During the study period , 149 patients died . Logistic models identified the lowest intradialysis systolic blood pressure ( SBP ) and degree of fall in SBP upon st and ing soon after hemodialysis as significant factors affecting mortality , but not pre- or postdialysis SBP and diastolic BP . The adjusted odds ratio for death was 0.79 ( 95 % CI 0.64 - 0.98 ) when the lowest intradialysis SBP was analyzed in increments of 20 mm Hg , and was 0.82 ( 95 % CI 0.67 - 0.98 ) when the fall in SBP upon st and ing soon after hemodialysis was analyzed in increments of 10 mm Hg . CONCLUSION These results suggest that intradialysis hypotension and orthostatic hypotension after hemodialysis are significant and independent factors affecting mortality in hemodialysis patients BACKGROUND Fluid overload is the main determinant of hypertension and left ventricular hypertrophy in hemodialysis patients . However , assessment of fluid overload can be difficult in clinical practice . We investigated whether objective measurement of fluid overload with bioimpedance spectroscopy is helpful in optimizing fluid status . STUDY DESIGN Prospect i ve , r and omized , and controlled study . SETTING & PARTICIPANTS 156 hemodialysis patients from 2 centers were r and omly assigned to 2 groups . INTERVENTION Dry weight was assessed by routine clinical practice and fluid overload was assessed by bioimpedance spectroscopy in both groups . In the intervention group ( n = 78 ) , fluid overload information was provided to treating physicians and used to adjust fluid removal during dialysis . In the control group ( n = 78 ) , fluid overload information was not provided to treating physicians and fluid removal during dialysis was adjusted according to usual clinical practice . OUTCOMES The primary outcome was regression of left ventricular mass index during a 1-year follow-up . Improvement in blood pressure and left atrial volume were the main secondary outcomes . Changes in arterial stiffness parameters were additional outcomes . MEASUREMENTS Fluid overload was assessed twice monthly in the intervention group and every 3 months in the control group before the mid- or end-week hemodialysis session . Echocardiography , 48-hour ambulatory blood pressure measurement , and pulse wave analysis were performed at baseline and 12 months . RESULTS Baseline fluid overload parameters in the intervention and control groups were 1.45 ± 1.11 ( SD ) and 1.44 ± 1.12 L , respectively ( P = 0.7 ) . Time-averaged fluid overload values significantly decreased in the intervention group ( mean difference , -0.5 ± 0.8 L ) , but not in the control group ( mean difference , 0.1 ± 1.2 L ) , and the mean difference between groups was -0.5 L ( 95 % CI , -0.8 to -0.2 ; P = 0.001 ) . Left ventricular mass index regressed from 131 ± 36 to 116 ± 29 g/m(2 ) ( P < 0.001 ) in the intervention group , but not in the control group ( 121 ± 35 to 120 ± 30 g/m(2 ) ; P = 0.9 ) ; mean difference between groups was -10.2 g/m(2 ) ( 95 % CI , -19.2 to -1.17 g/m(2 ) ; P = 0.04 ) . In addition , values for left atrial volume index , blood pressure , and arterial stiffness parameters decreased in the intervention group , but not in the control group . LIMITATIONS Ambulatory blood pressure data were not available for all patients . CONCLUSIONS Assessment of fluid overload with bioimpedance spectroscopy provides better management of fluid status , leading to regression of left ventricular mass index , decrease in blood pressure , and improvement in arterial stiffness BACKGROUND The use of lung ultrasonography to evaluate extravascular lung water and its consequences has received growing attention in different clinical areas , including , in recent years , end-stage renal disease patients treated by haemodialysis ( HD ) . Lung congestion is a direct consequence of either overall overhydration and /or cardiac dysfunction , but the exact contribution of each of these tests to mortality is unknown . METHODS In this prospect i ve observational study , we enrolled 96 patients from a single HD unit undergoing thrice weekly HD . We used three different methods of evaluation : lung ultrasonography ( pre- and post-dialysis ) , bioimpedance spectroscopy ( pre- and post-dialysis ) and echocardiography ( pre-dialysis ) . The objective of the study was to test for the first time the prognostic value of ultrasound lung comets ( ULC ) combined with bioimpedance-derived data [ total body water ( TBW ) , extravascular water , hydration status-ΔHS ] and several echocardiographic parameters . Mortality was analysed after a median of 405.5-day follow-up . RESULTS Pre-dialysis lung congestion was classified as moderate ( ULC = 16 - 30 ) in 19.8 % of the patients and severe in 12.5 % of patients ( ULC > 30 ) , while only 19.8 % appear to be hyperhydrated ( ΔHS > 15 % ) . The pre-dialysis ultrasound lung congestion score correlated significantly with all of the bioimpedance-derived parameters . In a multivariate Cox model that included ULC score , demographic , ecocardiographic and bioimpedance parameters , the factors that remained significantly associated with survival time were the pre-dialysis ULC score and left ventricular mass index . The pre-HD ULC score has a significant discriminating power for survival , while the bioimpedance-derived hydration status has no discriminatory abilities in terms of survival . CONCLUSIONS To our knowledge , this study is the first one that compares three different strategies to predict mortality in haemodialysed patients .  The lung comet score emerged as the best predictor for the relationship hydration status-mortality , independently of bioimpedance-derived parameters in this population Complications related to inadequate volume management are common during hemodialysis . This trial tested the hypothesis that availability of an intradialytic blood volume monitoring ( IBVM ) device improves fluid removal , reducing morbidity . A six-center , r and omized trial with 6 mo of intervention comparing IBVM using Crit-Line versus conventional clinical monitoring was conducted . The average rate of non-access-related hospitalizations was compared across treatment groups using Poisson regression . Mortality analysis used the Kaplan Meier method . A total of 227 patients were r and omized to Crit-Line , and 216 were r and omized to conventional monitoring . Both groups had similar baseline characteristics . During the study , no differences in weight , BP , or number of dialysis-related complications were observed . There were 120 and 81 non-access-related hospitalizations in the Crit-Line and conventional monitoring groups . The adjusted risk ratio for non-access-related and access-related hospitalization was 1.61 ( 95 % confidence interval 1.15 to 2.25 ; P = 0.01 ) and 1.52 ( 95 % confidence interval 1.02 to 2.28 ; P = 0.04 ) for the Crit-Line monitoring group . Mortality was 8.7 % in the Crit-Line monitoring group and 3.3 % in the conventional group ( P = 0.021 ) . St and ardized mortality ratios comparing the Crit-Line and conventional monitoring groups to the prevalent hemodialysis population were 0.77 ( NS ) and 0.26 ( P < 0.001 ) . Hospitalization rates were 1.51 and 1.03 events/yr in the Crit-Line and st and ard monitoring groups , compared 
    Output:
    
Conclusions Among maintenance dialysis recipients , technological adjuncts for fluid management did not improve survival .