***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: Provider and patient enthusiasm for  frequent home nocturnal hemodialysis ( FHNHD )  has been renewed ; however , the cost-effectiveness of this technique is unknown . We performed a cost-utility analysis of FHNHD compared with conventional hemodialysis ( CvHD ; 4 hours three times per week ) from a health payer perspective over a lifetime horizon using patient information from the Alberta NHD r and omized controlled trial .  Costs , including training costs , were obtained using microcosting and administrative data ( CAN$2012 ) . We determined the incremental cost per quality -adjusted life year ( QALY ) gained . Robustness was assessed using scenario , sensitivity , and probabilistic sensitivity analyses . Compared with CvHD ( 61 % in-center , 14 % satellite , and 25 % home dialysis ) , FHNHD led to incremental cost savings ( -$6700 ) and an additional 0.38 QALYs . In sensitivity analyses , when the annual probability of technique failure with FHNHD increased from 7.6 % ( reference case ) to ≥19 % , FHNHD became unattractive ( > $ 75,000/QALY ) . The cost/QALY gained became $ 13,000 if average training time for FHNHD increased from 3.7 to 6 weeks . In scenarios with alternate comparator modalities , FHNHD remained dominant compared with in-center CvHD ; cost/QALYs gained were $ 18,500 , $ 198,000 , and $ 423,000 compared with satellite CvHD , home CvHD , and peritoneal dialysis , respectively . In summary , FHNHD is attractive compared with in-center CvHD in this cohort . However , the attractiveness of FHNHD varies by technique failure rate , training time , and dialysis modalities from which patients are drawn , and these variables should be considered when establishing FHNHD programs BACKGROUND In this r and omized clinical trial , we aim ed to determine whether increasing the frequency of in-center hemodialysis would result in beneficial changes in left ventricular mass , self-reported physical health , and other intermediate outcomes among patients undergoing maintenance hemodialysis . METHODS Patients were r and omly assigned to undergo hemodialysis six times per week  ( frequent hemodialysis , 125 patients ) or three times per week  ( conventional hemodialysis , 120 patients ) for 12 months . The two co primary composite outcomes were death or change ( from baseline to 12 months ) in left ventricular mass , as assessed by cardiac magnetic resonance imaging , and death or change in the physical-health composite score of the R AND 36-item health survey . Secondary outcomes included cognitive performance ; self-reported depression ; laboratory markers of nutrition , mineral metabolism , and anemia ; blood pressure ; and rates of hospitalization and of interventions related to vascular access . RESULTS Patients in the frequent-hemodialysis group averaged 5.2 sessions per week ; the weekly st and ard Kt/V(urea ) ( the product of the urea clearance and the duration of the dialysis session normalized to the volume of distribution of urea ) was significantly higher in the frequent-hemodialysis group than in the conventional-hemodialysis group ( 3.54±0.56 vs. 2.49±0.27 ) . Frequent hemodialysis was associated with significant benefits with respect to both co primary composite outcomes ( hazard ratio for death or increase in left ventricular mass , 0.61 ; 95 % confidence interval [ CI ] , 0.46 to 0.82 ; hazard ratio for death or a decrease in the physical-health composite score , 0.70 ; 95 % CI , 0.53 to 0.92 ) . Patients r and omly assigned to frequent hemodialysis were more likely to undergo interventions related to vascular access than were patients assigned to conventional hemodialysis ( hazard ratio , 1.71 ; 95 % CI , 1.08 to 2.73 ) . Frequent hemodialysis was associated with improved control of hypertension and hyperphosphatemia . There were no significant effects of frequent hemodialysis  on cognitive performance , self-reported depression , serum albumin concentration , or use of erythropoiesis-stimulating agents . CONCLUSIONS Frequent hemodialysis , as compared with conventional hemodialysis , was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death or change in a physical-health composite score but prompted more frequent interventions related to vascular access . ( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; Clinical Trials.gov number , NCT00264758 . ) CONTEXT Morbidity and mortality rates in hemodialysis patients remain excessive . Alterations in the delivery of dialysis may lead to improved patient outcomes . OBJECTIVE To compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months . DESIGN , SETTING , AND PARTICIPANTS A 2-group , parallel , r and omized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006 . A total of 52 patients undergoing hemodialysis were recruited . INTERVENTION Participants were r and omly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly . MAIN OUTCOME MEASURES The primary outcome was change in left ventricular mass , as measured by cardiovascular magnetic resonance imaging . The secondary outcomes were patient-reported quality of life , blood pressure , mineral metabolism , and use of medications . RESULTS Frequent nocturnal hemodialysis significantly improved the primary outcome ( mean left ventricular mass difference between groups , 15.3 g , 95 % confidence interval [ CI ] , 1.0 to 29.6 g ; P = .04 ) . Frequent nocturnal hemodialysis did not significantly improve quality of life ( difference of change in EuroQol 5-D index from baseline , 0.05 ; 95 % CI , -0.07 to 0.17 ; P = .43 ) . However , frequent nocturnal hemodialysis was associated with clinical ly and statistically significant improvements in selected kidney-specific domains of quality of life ( P = .01 for effects of kidney disease and P = .02 for burden of kidney disease ) . Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure ( P = .01 after adjustment ) and mineral metabolism , including a reduction in or discontinuation of antihypertensive medications ( 16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group ; P < .001 ) and oral phosphate binders ( 19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group ; P < .001 ) . No benefit in anemia management was seen with nocturnal hemodialysis . CONCLUSION This preliminary study revealed that , compared with conventional hemodialysis ( 3 times weekly ) , frequent nocturnal hemodialysis improved left ventricular mass , reduced the need for blood pressure medications , improved some measures of mineral metabolism , and improved selected measures of quality of life . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N25858715 Prior small studies have shown multiple benefits of frequent nocturnal hemodialysis compared to conventional three times per week treatments . To study this further , we r and omized 87 patients to three times per week conventional hemodialysis or to nocturnal hemodialysis six times per week , all with single-use high-flux dialyzers . The 45 patients in the frequent nocturnal arm had a 1.82-fold higher mean weekly stdKt/V(urea ) , a 1.74-fold higher average number of treatments per week , and a 2.45-fold higher average weekly treatment time than the 42 patients in the conventional arm . We did not find a significant effect of nocturnal hemodialysis for either of the two co primary outcomes ( death or left ventricular mass ( measured by MRI ) with a hazard ratio of 0.68 , or of death or R AND Physical Health Composite with a hazard ratio of 0.91 ) . Possible explanations for the left ventricular mass result include limited sample size and patient characteristics . Secondary outcomes included cognitive performance , self-reported depression , laboratory markers of nutrition , mineral metabolism and anemia , blood pressure and rates of hospitalization , and vascular access interventions . Patients in the nocturnal arm had improved control of hyperphosphatemia and hypertension , but no significant benefit among the other main secondary outcomes . There was a trend for increased vascular access events in the nocturnal arm . Thus , we were unable to demonstrate a definitive benefit of more frequent nocturnal hemodialysis for either co primary outcome BACKGROUND Assessing health-related quality of life ( HRQOL ) can provide information on the types and degrees of burdens that afflict patients with chronic medical conditions , including end-stage renal disease ( ESRD ) . Several studies have shown important international differences among ESRD patients treated with hemodialysis  , but no studies have compared these patients ' HRQOL . Our goal was to document international differences in HRQOL among dialysis patients and to identify possible explanations of those differences . METHODS We examined data from the Dialysis Outcomes and Practice Patterns Study ( DOPPS ) , a prospect i ve , observational , international study of hemodialysis patients . We performed a cross-sectional analysis of DOPPS data from the United States , five countries in Europe ( France , Germany , Italy , Spain , and the United Kingdom ) , and Japan . Linear mixed models were used to analyze differences in HRQOL , using the KDQOL-SFTM . Norm-based scores were used to minimize cultural response bias . Linear regression analysis was used to adjust for confounding factors . Other variables included demographic variables , comorbidities , primary cause of ESRD , complications of ESRD and treatment , and socioeconomic status . RESULTS In all generic HRQOL subscales , patients on all three continents had much lower scores than their respective population norm values . Patients in the United States had the highest scores on the mental health subscale and the highest mental component summary scores .  Japanese patients reported better physical functioning than did patients in the United States or Europe , but they also reported the greatest burden of kidney disease . Overall , these differences remained even after adjusting for possible confounders . CONCLUSION On all three continents , ESRD and hemodialysis profoundly affect HRQOL . In the United States , the effects on mental health are smaller than in other countries . Japanese hemodialysis patients perceived that their kidney disease imposes a greater burden , but their physical functioning was significantly higher . Different distributions of socioeconomic factors and major comorbid conditions could explain little of this difference in physical functioning . Other possible factors , such as quality of dialysis and related health care , deserve careful study BACKGROUND Although several studies have shown that simulated annual direct health care costs are substantially lower for patients undergoing more frequent hemodialysis ( HD ) , there is limited information about the economics of daily HD and nocturnal HD . METHODS The London Daily/Nocturnal Hemodialysis Study compared the economics of  short daily HD ( n = 10 ) , long nocturnal HD ( n = 12 ) , and conventional thrice-weekly HD ( n = 22 ) in patients over 18 months . A retrospective analysis of patients '  conventional HD  costs during the 12 months before study entry was conducted to measure the change in cost after switching to quotidian HD . RESULTS As the data show , annual costs ( in Canadian dollars ) for daily HD are substantially lower than for both nocturnal HD and conventional HD : approximately 67,300 Can dollars , 74,400 Can dollars , and 72,700 Can dollars per patient , respectively . Moreover , marginal changes in operating cost per patient year were - 9,800 Can dollars , -17,400 Can dollars , and + 3,100 Can dollars for the daily HD , nocturnal HD , and conventional HD groups . Because of the increase in number of treatments , treatment supply costs per patient for the daily HD and nocturnal HD study groups were approximately twice those for conventional HD patients . However , average costs for consults , hospitalization days , emergency room visits , and laboratory tests for quotidian HD patients tended to decline after study entry . The major cost saving in home quotidian HD derived from the reduction in direct nursing time , excluding patient training . Total annualized cost per quality -adjusted life-year for the daily HD and nocturnal HD groups were 85,442 Can dollars and 120,903 Can dollars , which represented a marginal change of - 15,090 Can dollars and - 21,651 Can dollars , respectively , reflecting both improved quality of life and reduced costs for quotidian HD patients . CONCLUSION Substantial clinical benefits of home quotidian HD , combined with the economic advantage shown by this study , clearly justify its expansion BACKGROUND Kidney transplantation is the gold st and ard renal replacement therapy . Nocturnal haemodialysis ( NHD ) is an intensive dialysis modality ( 6 - 8 h/session , 3 - 7 sessions/week ) associated with a significant improvement of clinical and biochemical parameters compared to conventional dialysis . To date , no studies have compared survival in patients treated with NHD and kidney transplantation .  METHODS Using data from two regional NHD programmes and the USRDS from 1994 to 2006 , we performed a matched cohort study comparing survival between  NHD and deceased and living donor kidney transplantation ( DTX 
    Output:
    
The analysis comparing high-dose HD in-centre with conventional in-centre HD produced an incremental cost-effectiveness ratio generally acceptable for the USA , but not for Europe , Canada or Australia .
Conclusion High-dose HD can be cost effective when performed at home .