***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 AND OBJECTIVES Prognostic information is rarely conveyed by nephrologists because of clinical uncertainty about accuracy . The objective of this study was to develop an integrated prognostic model of 6-mo survival for patients who receive hemodialysis ( HD ) .  DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS A short-term prognostic model was developed using prospect i ve data from a derivation cohort of 512 patients who were receiving HD at five dialysis clinics . Patient charts were review ed for actuarial predictors ( e.g. , Charlson Comorbidity ) , and nephrologists answered the " surprise " question ( SQ ) , " Would I be surprised if this patient died within the next 6 mo ? " Survival was monitored for up to 24 mo . The prognostic model was tested with a validation cohort of 514 patients from eight clinics . RESULTS In a Cox multivariate analysis of the derivation cohort , five variables were independently associated with early mortality : Older age ( hazard ratio [ HR ] for a 10-yr increase 1.36 ; 95 % confidence interval [ CI ] 1.17 to 1.57 ) , dementia ( HR 2.24 ; 95 % CI 1.11 to 4.48 ) , peripheral vascular disease ( HR 1.88 ; 95 % CI 1.24 to 2.84 ) , decreased albumin ( HR for a 1-U increase 0.27 ; 95 % CI 0.15 to 0.50 ) , and SQ ( HR 2.71 ; 95 % CI 1.76 to 4.17 ) . Area under the curve for the result ing prognostic model predictions of 6-mo mortality were 0.87 ( 95 % CI 0.82 to 0.92 ) in the derivation cohort and 0.80 ( 95 % CI 0.73 to 0.88 ) in the validation cohort . CONCLUSIONS An integrated 6-mo prognostic tool was developed and vali date d for the HD population . The instrument may be of value for research ers and clinicians to improve end-of-life care by providing more accurate prognostic information BACKGROUND In contrast to the general population , a higher body mass index is associated with better survival among hemodialysis patients . Theoretically , high energy supplementation in these patients ought to lead to weight gain over time , but the benefits of this strategy are unclear . OBJECTIVE The objective was to assess whether high energy supplementation in nondiabetic hemodialysis patients might adversely affect insulin resistance -- a known risk factor for cardiovascular disease . DESIGN We first investigated the association between body fat mass and insulin resistance ( homeostasis model assessment of insulin resistance ; HOMA-IR ) in nondiabetic hemodialysis patients in a cross-sectional analysis ( study 1 ) . Of the 106 individuals studied , 55 were r and omly assigned to either high energy supplementation ( an extra 475 kcal/d ; n = 28 ) or not ( n = 27 ) for 12 wk to assess prospect i ve changes in body fat mass and insulin resistance ( study 2 ) . RESULTS In study 1 , body fat mass ( P < 0.05 ) and C-reactive protein ( CRP ) ( P < 0.05 ) each contributed independently to HOMA-IR .  In study 2 , 41 patients completed the study . The 20 patients who received high energy supplementation had a significantly greater increase in body fat mass ( P < 0.05 ) , CRP ( P < 0.05 ) , and HOMA-IR ( P < 0.001 ) than did the 21 controls . CONCLUSIONS Body fat mass and CRP are primary determinants of insulin resistance in nondiabetic hemodialysis patients .  High energy supplementation , because it increases adiposity and inflammation , exacerbates insulin resistance . A long-term study is needed to clarify the metabolic effects of high energy supplementation on cardiovascular disease outcomes in hemodialysis patients 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 BACKGROUND Several studies have pointed out the influence of nutritional parameters and /or indices of inflammation on morbidity and mortality . Often , these conditions coexist , and the relative importance of poor nutritional status and chronic inflammation in terms of predicting clinical outcomes in chronic hemodialysis ( CHD ) patients has not been clarified . METHODS We undertook a prospect i ve cohort study analyzing time-dependent changes in several established nutritional and inflammatory markers , and their influence on mortality in 194 CHD patients ( 53 % male , 36 % white , 30 % with diabetes mellitus , mean age 55.7 + /- 15.4 years ) throughout a 57-month period .  Serial measurements of serum concentrations of albumin , prealbumin , creatinine , transferrin , cholesterol , and C-reactive protein ( CRP ) , as well as normalized protein catabolic rate , postdialysis weight , and phase angle and reactance by bioelectrical impedance analysis were performed every 3 months . Clinical outcomes were simultaneously assessed using indicators of mortality . RESULTS Serum albumin , serum prealbumin , serum creatinine , and phase angle were significant predictors of all-cause mortality , even after adjustment for serum CRP concentrations . Serum CRP concentrations were not significantly associated with mortality . Serum albumin concentrations and phase angle were also independent predictors of cardiovascular deaths in the multivariate model . CONCLUSION The nutritional status of CHD patients predicts mortality independent of concomitant presence or absence of inflammatory response . Prevention of , and timely intervention to treat uremic malnutrition by suitable means are necessary independent of the presence and /or therapy of inflammation in terms of improving clinical outcomes in CHD patients Background : Malnutrition-inflammation score ( MIS ) is a comprehensive and quantitative system to assess malnutrition-inflammation complex syndrome , and a strong correlation between MIS and morbidity/mortality in maintenance hemodialysis ( MHD ) patients had been demonstrated . However , there is no cut-off value of MIS to categorize patients into high risk or low risk patients . Methods : A total of 257 chronic stable and ambulatory adult MHD patients from Far Eastern Memorial Hospital were enrolled for the study . The MIS of each patient was recorded at the initiation of study and the study population was followed up as a 12-month prospect i ve cohort to evaluate mortality as the primary outcome . Results : Twelve patients died in the 12-month observational period . Both multiple logistic regression analyses and Cox proportional hazards model denoted MIS , alkaline phosphatase , transferrin saturation , ferritin , and total iron binding capacity as significant predictors of 1-year mortality . The conditional effect plot of MIS on 1-year mortality revealed that when fixing the alkaline phosphatase , transferrin saturation , ferritin , and total iron binding capacity at a mean value , the probability of death for an MHD patient whose MIS was 3 , 4 , and 5 is 10 , 40 , and 80 % , respectively . Conclusions : Our study shows that MHD patients with MIS score of more than 4–5 had a significant risk of 1-year mortality . Additional risk factors associated with short-term mortality besides malnutrition-inflammation complex syndrome were anemia and renal osteodystrophy . This study proves that MIS is a useful tool to risk-stratify Asian MHD patients and to identify those at risk of short-term death . Nutritional interventions that can improve the MIS may also improve survival , but this hypothesis needs to be verified in interventional studies BACKGROUND Hypoalbuminemia is associated with substantial morbidity and mortality in dialysis patients . METHODS Subjects with a mean three-month pre study serum albumin of 3.8 g/dL or less and who demonstrated > /=90 % compliance during a two-week run-in period were r and omized to 3.6 g of essential amino acids ( EAAs ) or placebo three times daily with meals for three months . R and omization was stratified by dialysis modality and by severity of the hypoalbuminemia . The primary study outcome was change in the average of three monthly serum albumin measurements between baseline and follow-up . RESULTS Fifty-two patients were r and omized ; 47 patients ( 29 hemodialysis and 18 peritoneal dialysis ) met the predetermined primary analysis criteria . The mean compliance rates averaged 75 , 70 , and 50 % at months 1 , 2 , and 3 , respectively , and were similar for EAAs and placebo .  Serum albumin in the hemodialysis patients , EAA versus placebo , improved [ ( mean + /- SE ) 0.22 + /- 0.09 g/dL , P = 0.02 ] . Changes in peritoneal dialysis patients were not significant ( 0.01 + /- 0.15 g/dL ) , but approached significance for the total study group ( 0.14 + /- 0.08 g/dL , P = 0.08 ) . Patients in the very low albumin strata ( < 3.5 g/dL ) improved more than those in the low albumin strata ( 3.5 to 3.8 g/dL , P < 0.01 ) . There was a significant correlation ( r = 0.83 , P = 0.001 ) within the hemodialysis EAA group between the baseline C-reactive protein level and improvement in serum albumin . Improvements were also seen in grip strength and SF-12 mental health score , but not in serum amino acid levels , SF-12 physical health score , or anthropometric measurements . CONCLUSIONS Oral EAAs induce a significant improvement in the serum albumin concentration in hemodialysis but not peritoneal dialysis subjects . Further study of their long-term effects on morbidity and mortality is warranted OBJECTIVE This controlled trial was undertaken to evaluate the benefits of short-term enteral nutrient supplementation in maintenance hemodialysis ( MHD ) patients using a high-calorie and high-protein blend formula ( low-cost home-prepared [ HP ] blend or a commercially available supplement ) and to study its effect on selected parameters of nutritional status . The acceptability and palatability of the HP blend formula , ease of use , and cost were also assessed in comparison with the commercial nutritional supplement ( CNS ) . DESIGN R and omized controlled trial . SETTING Hemodialysis ( HD ) unit of a tertiary referral care hospital in Southern India . PATIENTS Nondiabetic adult MHD patients with no intercurrent illness , on regular thrice weekly MHD for at least 1 month before recruitment , with a body mass index ( BMI ) < 20 and a serum albumin level of < 4.0 g/dL. Patients were r and omized into control group and experimental group , the latter in turn to recieve either CNS or HP blend . INTERVENTION The control group received appropriate monitoring , including dietary recall and counselling for the prescribed diet ( protein intake of 1.2 g/kgIBW/d and energy of 35 to 45 kcal/kgIBW/d ) but no specific post-HD supplement . Patients in the supplement group received the respective supplement post-HD ( providing 500 kcal and 15 g protein ) for 1 month in addition to the monitored diet prescription . MAIN OUTCOME MEASURES ( 1 ) Nutritional status parameters , BMI and serum albumin ; ( 2 ) functional status on a 10-point Karnofsky scale ; ( 3 ) adverse metabolic effects , hyperphosphatemia at start and end of study ; and ( 4 ) subjective scoring for appetite , and acceptability of and tolerance to supplement . RESULTS Both groups showed an improvement in dry weight and BMI . In addition , the supplement group showed a significant increase in serum albumin level and functional scoring . Mild hyperphosphatemia occurred in the supplement group . An increase in baseline food intake was seen in the control group , but not in the supplemented group . No intolerance was reported to either supplement . CONCLUSION Enteral nutrient supplementation was shown to bring about a significant improvement in serum albumin level even in a short-term study . Use of an HP supplement was beneficial , acceptable , and inexpensive INTRODUCTION Malnutrition is multifactorial and may be modified by nutritional intervention . We aim ed to assess the impact of an intervention on the nutritional status of malnourished hemodialysis patients and their acceptance of a non- 
    Output:
    
Albumin levels may be improved by the macronutrient blends or protein/amino acid supplements in MDT patients .
ONS may not influence serum phosphorus and potassium levels .
CONCLUSIONS Very low- quality evidence suggests that Short-term oral energy or protein/amino acid supplements may improve nutritional status by increasing serum albumin levels and BMI in MDT patients , without influence on serum potassium levels .