***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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    Input: Depression is an important target of psychological assessment in patients with end-stage renal disease because it predicts their morbidity , mortality , and quality of life . We assessed the effectiveness of cognitive-behavioral therapy in chronic hemodialysis patients diagnosed with major depression by the Mini International Neuropsychiatric Interview ( MINI ) . In a r and omized trial conducted in Brazil , an intervention group of 41 patients was given 12 weekly sessions of cognitive-behavioral group therapy led by a trained psychologist over 3 months while a control group of 44 patients received the usual treatment offered in the dialysis unit . In both groups , the Beck Depression Inventory , the MINI , and the Kidney Disease and Quality of Life-Short Form question naires were administered at baseline , after 3 months of intervention or usual treatment , and after 9 months of follow-up . The intervention group had significant improvements , compared to the control group , in the average scores of the Beck Depression Inventory overall scale , MINI scores , and in quality -of-life dimensions that included the burden of renal disease , sleep , quality of social interaction , overall health , and the mental component summary . We conclude that cognitive-behavioral group therapy is an effective treatment of depression in chronic hemodialysis patients BACKGROUND The medical risk factors associated with increased mortality in hemodialysis ( HD ) patients are well known , but the psychosocial factors that may affect outcome have not been clearly defined . Psychosocial factors could affect mortality through interaction with parents ' nutrition or their compliance with the dialysis prescription . We conducted a prospect i ve , longitudinal , multicenter study of urban HD patients to determine the contribution of compliance and psychosocial factors to patient survival . METHODS Patients were assessed using indices of social support , patient 's assessment s of their well-being , including illness effects ( IEQ ) , and satisfaction with life ( SWLS ) , the Beck Depression Inventory ( BDI ) , serum albumin concentration , Kt/V and protein catabolic rate ( PCR ) . Behavioral compliance was measured three ways : percent time actually dialyzed per treatment compared to prescribed time ( shortening behavior ) ; percent sessions attended ( skipping behavior ) and total integrated time compliance ( % TCOMP ) . A severity index , previously demonstrated to be a mortality marker , was used to grade medical comorbidity . The typed of dialyzer the patient was treated with was noted . A Cox proportional hazards model , controlling for age , medical comorbidity , albumin concentration and dialyzer type was used to assess relative mortality risk of variations in psychosocial factors and behavioral compliance . RESULTS A total of 295 patients ( 60.8 % of those eligible ) agreed to participate . The mean ( + /- SD ) age of our population was 54.6 + /- 14.1 year , mean PCR was 1.06 + /- 0.27 g/kg/day , and mean Kt/V 1.2 + /- 0.4 , suggesting the patients were well nourished and adequately dialyzed . The patients ' mean BDI was 11.4 + /- 8.1 ( in the range of mild depression ) . Patients ' SWLS was similar to that of a group of patients without chronic illness . After a 26 month mean follow-up period , higher levels of perceived social support , improved perception of the effects of illness and increased behavioral compliance were significantly associated with decreased relative mortality risk ( 0.8 , 0.77 , and 0.79 , respectively ) , controlled for variations in patients ' age , severity of illness , serum albumin concentration and dialyzer type . Variations in depression and Kt/V were not predictors of mortality during the observation period . CONCLUSIONS Lower levels of social support , decreased behavioral compliance with the dialysis prescription  , and increased negative perception of the effects of illness are independently associated with increased mortality in ESRD patients treated with HD . The effects are of the same order of magnitude as medical risk factors . Such effects may be attributable to a relationship between a patients ' perception of social support and effects of illness and behavior , with other factors such as the provision of better medical care in patients with larger social networks . The mechanism underlying the relationship of psychosocial factors and compliance and survival , and the effect of interventions to improve perception of illness , and increase social support and compliance with the dialysis prescription in HD patients should be studied BACKGROUND The aim of this study was to evaluate the survival of patients initiating haemodialysis ( HD )  , and to analyse whether low health-related quality of life ( HRQoL ) levels are predictors of mortality in the short-term , controlling certain variables that had been shown in other studies to have a bearing on survival , and using scores , st and ardized for age and sex , of the HRQoL measurement tool employed . METHODS This is a multicentric prospect i ve study of all patients on HD in all the dialysis units in Asturias , a region with a little over one million inhabitants , from 1 January 2001 to 30 September 2002 . A total of 199 patients initiated HD in our region and survived the first 3 months . Of these , 137 patients who remained on HD for at least 3 months had complete responses on HRQoL measures . RESULTS It was observed that adjusted relative risk ( RR ) of death increased by 5 % for each year of age increase ( RR=1.05 , 95 % CI 1.01 - 1.09 : P=0.006 ) ; in the same way , for each increase in the Mental Component Summary ( MCS ) score , the adjusted RR of death diminished by 4 % ( RR=0.96 , 95 % CI 0.94 - 0.99 ; P=0.006 ) . CONCLUSION Mental health has been shown to be a factor independently associated with mortality ; as the MCS score worsens the adjusted RR of death of a patient on HD increases The aims of the present study were to determine the prevalence of depression in our dialysis patients , to detect the most powerful variables associated with depression , and to determine the role of depression in prediction of mortality . The prospect i ve follow-up study of 128 patients ( 77 HD and 51 CAPD , 65 male , aged 53.8 + /- 13.5 years , dialysis duration 64.7 + /- 64.8 months ) was carried out over 36 months . Depression by the  Beck Depression Inventory-BDI-II score , laboratory parameters ( hemoglobin , serum albumin and creatinine concentration ) , immunological status ( cytokines and hsCRP ) , comorbidity by Index of Physical Impairment ( IPI ) and adequacy of dialysis by Kt/V were monitored . The overall prevalence of depression in the dialysis patients ( BDI score > or = 14 ) was 45.3 % , and 28.2 % , respectively , for moderate and severe depression ( BDI > or = 20 ) . The most powerful variable associated with depression was IL-6 , but associations with albumin , hemoglobin , creatinine and IPI score were also found . During the follow-up period 36 patients died , 7 patients left the cohort and 2 patients were transplanted . If IPI score was not included in the multivariate Cox analysis , the BDI score remained one of the best predictors of mortality along with albumin . In conclusion , because of the close association of depression with inflammation , malnutrition , and cardiovascular mortality , it could be speculated that depression is one branch of the MIA ( malnutrition , inflammation , atherosclerosis ) syndrome This study investigated whether social and /or psychologic factors help to predict older dialysis patients ' continued survival . A stratified ( by race and sex ) r and om sample of patients aged 60 + years was selected from the ESRD Network census of all patients in that age category residing in a single southeastern state ( Georgia ) and receiving chronic dialysis as of November 1987 ;  personal interviews with patients were completed in 1988 . This analysis includes 287 patients ( mean age , 69 years ) receiving outpatient hemodialysis for whom primary cause of renal failure and functional status data were complete . Patient tracking and vital statistics data determined that 49 % of the sample survived as of October 31 , 1990 . Study variables included demographic , dialysis , health status , social situation , and psychologic outlook variables reported at the patients ' 1988 interviews . Log rank tests showed univariate associations between patients ' continued survival and race/gender , recovery time following dialysis treatments , cardiovascular co-morbidity , exercise activity score , freedom from health limitation of daily activity , functional status , leisure activity score , self-rated health status , overall life satisfaction , depression , and public religiosity . The Cox proportional hazards model was fit to the data , with continued survival from the time of the 1988 interview as the dependent variable . There was a significantly increased mortality risk for white men relative to the other race/gender groups and for patients reporting severely impaired functional status at the 1988 interview . With functional status in the model , no other social or psychologic variables were significant predictors of mortality . ( ABSTRACT TRUNCATED AT 250 WORDS Objective : To assess the effects of intradialytic exercise training on health-related quality of life indices in haemodialysis patients . Subjects/ patients : Thirty-five patients on haemodialysis , with a mean ( SD ) age of 48.8 ( 13.9 ) years , volunteered to participate in the study . They were r and omized either to rehabilitation group ( group A : 19 patients ) , following a 10-month intradialytic exercise training programme or to  control group ( group B : 14 patients ) . After the r and omization , two of the patients , one of each group , withdrew from the study for reasons unrelated to exercise training . Method : All patients at the beginning and the end of the study underwent clinical examination , laboratory tests and a treadmill exercise testing with spiroergometric study for the evaluation of their aerobic capacity ( Vo2peak ) . A formal psychosocial assessment , which included affective ( Beck Depression Inventory ) , health-related quality of life ( Quality of Life Index , Living Question naire of Minnesota , Life Satisfaction Index and Short Form-36 question naire ) and personality ( Eysenck Personality Question naire ) parameters , was evaluated at beginning and end of the study . The dose of erythropoietin was changed as needed , according to the level of the haemoglobin , aim ing to keep it at 11 ( 2 ) g/dL during the study . Results : Baseline values were similar between the two groups . After training in group A , Vo2peak was increased by 21.1 % ( P<0.05 ) and exercise time by 23.6 % ( P<0.05 ) . Moreover , group A showed a decrease in self-reported depression ( Beck Depression Index ) of 39.4 % ( P<0.001 ) . In addition , trained patients demonstrated a significant improvement in Quality of Life Index ( from 6.5 ( 1.8 ) to 9.0 ( 1.3 ) , P<0.001 ) and Life Satisfaction Index ( from 44.8 ( 8.6 ) to 53.0 ( 5.6 ) , P<0.001 ) , and an increase in the Physical Component Scale of the SF-36 ( from 40.5 ( 5.6 ) to 44.5 ( 5.5 ) , P<0.05 ) , while the Mental Component Scale remained unchanged . Multiple regression analysis indicated that the improvement in quality of life depended on the participation in exercise programmes , the effects of training and the reduction in the level of depression . No changes were observed in Eysenck Personality Question naire by the end of the study , while all the above parameters remained almost unchanged in the controls . Conclusion : The results demonstrated that intradialytic exercise training improves both physical functioning and psychological status in haemodialysis patients , leading to an improvement of patients ' quality of life AIM To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease ( ESRD ) patients on renal replacement therapy ( RRT ) .  METHODS In a prospect i ve fashion , symptoms of depression were evaluated in ESRD patients on RRT  using the depression subscore of the Hospital Anxiety and Depression Scale ( HADS ) . Fatal and non-fatal clinical events were determined during a 1-year follow-up . RESULTS Of 101 patients with ESRD , 42 % showed manifest depressive symptoms , defined as a HADS-D score > or = 7 . No association was found between depressive symptoms and severity of somatic disease . During follow-up , all-cause mortality was significantly higher in patients with depressive symptoms above threshold ( n = 42 , mortality : 26 % ) compared to patients with depressive symptoms below threshold ( n = 59 , mortality 8 % ) , ( crude HR 3.3 , CI 1.2 - 9.6 , P = 0.02 ) . The excess in mortality was mainly caused by a higher incidence of septicaemia ( 0 versus 12 % , P = 0.01 ) . After adjustment for clinical parameters , this association between depressive symptoms and mortality became even stronger . There was no significant difference observed in the incidence of cardiovascular events . CONCLUSIONS Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival . Future research should address appropriate therapeutic regimens BACKGROUND The relationship between severity of depressive symptoms reported by incident dialysis patients and first-year outcomes is not known . METHODS We evaluated the association between  self-report of depressive symptoms in incident hemodialysis patients admitted at Fresenius Medical Care North America facilities between 1 January and 31 December 2006 and mortality 
    Output:
    
There is considerable between- study heterogeneity in reports of depressive symptoms in dialysis patients , likely caused by high variability in the way depressive symptoms are measured .