***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 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Poor adherence to treatment is common in patients on hemodialysis which may increase risk for poor clinical outcomes and mortality . Self management interventions have been shown to be effective in improving compliance in other chronic population s. The aim of this trial is to evaluate the effectiveness of a recently developed group based self management intervention for hemodialysis patients compared to st and ard care . Methods / Design This is a multicentre parallel arm block r and omized controlled trial ( RCT ) of a four session group self management intervention for  hemodialysis patients delivered by health care professionals compared to st and ard care .  A total of 176 consenting adults maintained on hemodialysis for a minimum of 6 months will be r and omized to receive the self management intervention or st and ard care . Primary outcomes are biochemical markers of clinical status and adherence . Secondary outcomes include general health related quality of life , disease-specific quality of life , mood , self efficacy and self-reported adherence . Outcomes will be measured at baseline , immediately post-intervention and at 3 and 9 months post-intervention by an independent assessor and analysed on intention to treat principles with linear mixed-effects models across all time points . A qualitative component will examine which aspects of program participants found particularly useful and any barriers to change . Discussion The NKF-NUS intervention builds upon previous research emphasizing the importance of empowering patients in taking control of their treatment management . The trial design addresses weaknesses of previous research by use of an adequate sample size to detect clinical ly significant changes in biochemical markers , recruitment of a sufficiently large representative sample , a theory based intervention and careful assessment of both clinical and psychological endpoints at various follow up points . Inclusion of multiple dependent variables allows us to assess the broader impact on the intervention including both hard end points as well as patient reported outcomes . This program , if found to be effective , has the potential to be implemented within the existing renal services delivery model in Singapore , particularly as this is being delivered by health care professionals already working with hemodialysis patients in these setting s who are specifically trained in facilitating self management in renal patients .Trial registration Current Controlled Trials Background Chronic kidney disease ( CKD ) is one of the most serious public health problems . The increasing prevalence of CKD in developed and developing countries has led to a global epidemic . The hypothesis proposed is that patients undergoing dialysis  would experience a marked negative influence on physiological variables of sleep and autonomic nervous system activity , compromising quality of life . Methods / Design A prospect i ve , consecutive , double blind , r and omized controlled clinical trial is proposed to address the effect of dialysis on sleep , pulmonary function , respiratory mechanics , upper airway collapsibility , autonomic nervous activity , depression , anxiety , stress and quality of life in patients with CKD . The measurement protocol will include body weight ( kg ) ; height ( cm ) ; body mass index calculated as weight/height2 ; circumferences ( cm ) of the neck , waist , and hip ; heart and respiratory rates ; blood pressures ; Mallampati index ; tonsil index ; heart rate variability ; maximum ventilatory pressures ; negative expiratory pressure test  , and polysomnography  ( sleep study ) , as well as the administration of specific question naires addressing sleep apnea , excessive daytime sleepiness , depression , anxiety , stress , and quality of life . Discussion CKD is a major public health problem worldwide , and its incidence has increased in part by the increased life expectancy and increasing number of cases of diabetes mellitus and hypertension . Sleep disorders are common in patients with renal insufficiency . Our hypothesis is that the weather weight gain due to volume overload observed during interdialytic period will influence the degree of collapsibility of the upper airway due to narrowing and predispose to upper airway occlusion during sleep , and to investigate the negative influences of haemodialysis in the physiological variables of sleep , and autonomic nervous system , and respiratory mechanics and thereby compromise the quality of life of patients .Trial registration The protocol for this study is registered with the Brazilian Registry of Clinical Trials ( ReBEC RBR-7yhr4w and World Health Organization under Universal Trial Number UTN : U1111 - 1127 - 9390 [ http://www.ensaiosclinicos.gov.br/rg/RBR-7yhr4w/ ] ) Background Functional limitations , altered cardiac autonomic activity , and psychological distress are known disorders in chronic hemodialysis ( HD ) patients , relating to increased morbidity and mortality . The aim of this study was to examine the influence of an exercise training program on emotional parameters and heart rate variability ( HRV ) indices , as well as to determine whether emotional stress contributes to autonomic dysfunction in these patients . Methods Forty-four HD patients were r and omly assigned into group A ( 24 patients , aged 46.3 ± 11.2 years ) , who participated in a 1-year intradialytic exercise training program and group B ( 20 patients , aged 45.8 ± 10.8 years ) , who were used as controls . At baseline and a year after , measures of HRV were obtained for the estimation of st and ard deviation of RR intervals , the mean square successive differences , percentage of RR intervals differing by more than 50 ms from the preceding RR interval ( pNN50 ) , and low to high frequency components . Emotional parameters ( Beck Depression Inventory – BDI and Hospital Anxiety and Depression Scale – HADS ) were also assessed by vali date d question naires . Moreover , all patients performed a spiroergometric study for the estimation of VO2peak . Results At baseline , all measurements were similar in the two groups and remained almost unchanged after a year in group B. After a year of training , VO2peak increased from 16.79 ± 5.24 to 22.33 ± 4.90 ml/kg per min ( P > 0.001 ) in group A. Trained patients also showed an increase in st and ard deviation of RR intervals by 58.8 % ( P > 0.001 ) , the mean square successive differences by 68.1 % ( P > 0.001 ) , pNN50 by 23.5 % ( P > 0.001 ) , and a low to high frequency ratio by 17.3 % ( P > 0.001 ) . Finally , at the end of the study , group A showed a decrease in BDI score by 34.5 % ( P > 0.001 ) and HADS by 23.9 % ( P > 0.001 ) . Canonical correlation revealed significant inverse correlation among depression ( in BDI and HADS ) and HRV indices before and after exercise training . Conclusion Cardiac autonomic modulation seemed to be sensitive to the experience of persistent depression in HD patients .  Significantly , exercise training  reduced emotional distress and concomitantly improved HRV Background Patients with end-stage renal disease ( ESRD ) commonly suffer from severe fatigue , which strongly impacts their quality of life ( QoL ) . Although fatigue is often attributed to disease- and treatment characteristics , research also shows that behavioural , psychological and social factors affect perceived fatigue in dialysis patients . Whereas studies on fatigue in other chronic patient groups suggest that psychological or psychosocial interventions are effective in reducing fatigue , such interventions are not yet available for ESRD patients on dialysis treatment . The objective of this study is to examine the efficacy of a psychosocial intervention for dialysis patients aim ed at reducing fatigue ( primary outcome ) and improving QoL ( secondary outcome ) . The intervention consists of counselling sessions led by a social worker . The implementation process and patients ’ and social workers ’ expectations and experiences with the intervention will also be evaluated . Methods / Design This study follows a mixed- methods design in which both quantitative and qualitative data will be collected . A multi-centre , r and omised controlled trial ( RCT ) with repeated measures will be conducted to quantitatively assess the efficacy of the  psychosocial intervention  in reducing fatigue and improving QoL in ESRD patients . Additional secondary outcomes and medical parameters will be assessed . Outcomes will be compared to patients receiving usual care . A sample of 74 severely fatigued dialysis patients will be recruited from 10 dialysis centres . Patients will be r and omly assigned to the intervention or control group . Outcomes will be assessed at baseline , post intervention/16 weeks , and at three and six-month follow-ups . A qualitative process evaluation will be conducted parallel to/following the effectiveness RCT . Interviews and focus groups will be conducted to gain insight into patients ’ and social workers ’ perspectives on outcomes and implementation procedures . Implementation fidelity will be assessed by audio-taped and written registration s. Participatory methods ensure the continuous input of experiential knowledge , improving the quality of study procedures and the applicability of outcomes . Discussion This is the first mixed method study ( including an RCT and qualitative process evaluation ) to examine the effect and implementation process of a  psychosocial intervention on reducing fatigue and improving QoL in ESRD patients on dialysis treatment . Trial registration NTR5366 , The Netherl and s National Trial Register ( NTR ) , registered August 26 , 2015 Abstract Background Depression is common in haemodialysis ( HD ) patients and associated with poor outcomes . Purpose To evaluate whether depression symptoms predict survival and transplantation in a large sample of haemodialysis patients using cause-specific survival models . Methods Survival data was collected between April 2013 and November 2015 , as part of the screening phase of a multicentre r and omised placebo-controlled trial of  sertraline in HD patients .  Depression was measured using the Beck Depression Inventory-II ( BDI-II ) and the Patient Health Question naire-9 ( PHQ-9 ) . Demographic and clinical data were collected via a self-report question naire and medical records . Competing risk survival analysis involved cause-specific and subdistribution hazard survival models . All models were adjusted for appropriate covariates including comorbidity and C-reactive protein ( CRP ) in a sub analysis . Results Of 707 cases available for analysis , there were 148 deaths . The mean survival time was 787.5 days . Cumulative survival at 12 months was 88.5 % . During the study follow-up period , there were 92 transplants . The cumulative transplant event rate at 12 months was 7.8 % . In separate adjusted models , depression symptoms predicted mortality ( BDI-II HR = 1.03 95 % CI 1.01 , 1.04 ; PHQ-9 HR = 1.04 95 % CI 1.01 , 1.06 ) . With respect to screening cut-off scores , a PHQ-9 ≥ 10 was associated with mortality ( HR = 1.51 95 % CI 1.01 , 2.19 ) but not a BDI-II ≥ 16 . Depression symptoms were not associated with time to transplantation in either cause-specific or subdistribution model . Conclusions Consistent with past findings in HD patients , depression symptoms predicted survival but were not associated with kidney transplantation . Suitable treatments for depression need further evaluation , and their impact upon quality of life and clinical outcomes determined . Trial Registration Number ( IS RCT N06146268 ) Twenty-one patients undergoing regular hemodialysis completed a trial of energy supplementation . Nine patients added the glucose polymer Polycose to their usual diet and 12 acted as control subjects . The supplemented patients were asked to incorporate 100 or 150 g polymer , equivalent to 1600 or 2400 kJ ( 400 or 600 kcal ) into their usual diet , daily for 6 mo . This result ed in a mean increase in energy intake of 1630 kJ ( p less than 0.05 ) and a mean weight gain of 3.1 kg ( p less than 0.005 ) . The addition of glucose polymer to the diet result ed in a mean increase in body fat of 1.8 kg and the lean body mass increased by 1.3 kg . No significant effect on plasma triglycerides , urea , or creatinine was detected . The intake of macro- and micronutrients was not adversely affected and no clinical or psychological side effects were reported . Follow-up of these patients showed that the weight gain was maintained after 6 mo . Glucose polymer was an effective energy supplement that had beneficial effects on the nutritional status of hemodialysis patients This study assessed the effect and feasibility of morning bright light therapy ( BLT ) on sleep , circadian rhythms , subjective feelings , depressive symptomatology and cognition in renal transplant recipients ( RTx ) diagnosed with sleep-wake disturbances ( SWD ) . This pilot r and omized multicentre wait-list controlled trial included 30 home-dwelling RTx r and omly assigned 1:1 to either 3 weeks of BLT or a wait-list control group . Morning BLT ( 10 000 lux ) was individually scheduled for 30 min daily for 3 weeks . Wrist actimetry ( measuring sleep and circadian rhythms ) , vali date d instruments ( subjective feelings and cognition ) and melatonin assay ( circadian timing ) were used . Data were analysed via a r and om-intercept regression model . Of 30 RTx recipients ( aged 58 ± 15 , transplanted 15 ± 6 years ago ) , 26 completed the study .  While BLT had no significant effect on circadian and sleep measures , sleep timing improved significantly . The intervention group showed a significant get-up time phase advance from baseline to intervention ( + 24 min ) [ ( st and ardized estimates ( SE ) : -0.23 ( -0.42 ; -0.03 ) ] and a small ( + 14 min ) but significant bedtime phase advance from intervention to follow-up ( SE : -0.25 ( -0.41 ; -0.09 ) . Improvement in subjective feelings and depressive symptomat 
    Output:
    
Cognitive behavioural therapy may reduce major depression symptoms ( one study ) and anxiety , and increase self-efficacy ( one study ) .
Cognitive behavioural therapy , exercise or relaxation techniques probably reduce depressive symptoms ( moderate-certainty evidence ) for adults with ESKD treated with dialysis .
Cognitive behavioural therapy probably increases health-related quality of life .
Evidence for spiritual practice s , acupressure , telephone support , and meditation is of low certainty .