***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: Elderly patients with end-stage renal disease often have protein and /or caloric malnutrition that severely affects general well-being and mortality . Uremia is associated with resistance to the action of growth hormone ( GH ) . This resistance could be of clinical importance in elderly dialysis patients . In the present study , the effects of GH treatment were assessed in elderly patients receiving chronic hemodialysis . Twenty hemodialysis patients with a mean age of 71.7 years ( range , 53 to 92 years ) were included on a 6-month , r and omized , double-blind , placebo-controlled trial of GH treatment . The dose of GH was 66.7 microgram/kg , administered subcutaneously three times weekly immediately after each dialysis session . Body composition was measured using total-body potassium levels , computed tomography of the lower leg , and bioelectrical impedance analysis . Serum albumin concentrations and h and grip strength were also measured . GH treatment increased the serum concentration of insulin-like growth factor-I ( IGF-I ) , IGF-I/IGF-binding protein-3 ratio , fat-free mass , and the serum concentration of albumin compared with placebo . The number of patients with serum albumin levels less than 40 g/L was reduced by a factor of three in the GH-treated group . H and grip strength increased in response to GH treatment compared with placebo . Six months of GH treatment in elderly hemodialysis patients produced anabolic effects , with improved muscle performance . Also , the number of patients with low albumin levels was markedly reduced , indicating improved nutritional status and /or attenuated catabolism . These are all important beneficial effects for individual patient outcomes BACKGROUND Serum albumin has limitations as a nutritional marker in patients undergoing peritoneal dialysis ( PD ) in that it is affected by inflammation , systemic disease , overhydration , and urinary and dialysate protein loss . H and grip strength is a simple , easily performed bedside test that has been shown to correlate with lean body mass in patients close to inception of dialysis . OBJECTIVE We evaluated the associations of h and grip strength with other clinical factors and examined its relations with mortality and cardiovascular death in PD patients . DESIGN We prospect ively enrolled 233 chronic PD patients and assessed  h and grip strength  and other variables at baseline and then followed the patients for a mean ( + /-SD ) of 30 + /- 14 mo . RESULTS Baseline h and grip strength was significantly associated with age , sex , height , diabetes , residual glomerular filtration rate ( GFR ) , and hemoglobin but not with C-reactive protein ( CRP ) . After adjustment for age , sex , and height , h and grip strength was most strongly correlated with lean body mass on the basis of creatinine kinetics ( r = 0.334 , P < 0.001 ) , followed by serum albumin and subjective global assessment . Both men and women who died had lower h and grip strengths than did those who remained alive ( P < 0.001 ) . After control for age , sex , diabetes , atherosclerotic vascular disease , GFR , hemoglobin , CRP , and serum albumin , greater h and grip strength was predictive of lower all-cause [ hazards ratio ( HR ) : 0.95 ( 95 % CI : 0.92 , 0.99 ) ; P = 0.005 ] and cardiovascular [ HR : 0.94 ( 0.90 , 0.98 ) ; P = 0.004 ] mortality . CONCLUSIONS H and grip strength not only is a marker of body lean muscle mass but also provides important prognostic information independent of other covariates , including CRP and serum albumin . Our data suggest that h and grip strength may be used in conjunction with serum albumin as a nutrition-monitoring tool in patients undergoing PD BACKGROUND & AIMS Muscle wasting is considered the best marker of protein-energy wasting in end-stage renal disease ( ESRD ) . We tested the usefulness of a simple observer subjective muscle atrophy ( MA ) grading in relation to morbidity and mortality in ESRD patients . METHODS In two different ESRD cohorts ( 265 incident patients starting dialysis and 221 prevalent hemodialysis patients ) , each patient 's degree of MA was visually grade d by a trained nurse on a scale from 1 to 4 as part of the subjective global assessment . This score was confronted with inflammatory and nutritional indexes as well as objective measurements of muscle atrophy . Patients were then prospect ively followed for up to four or six years , depending on the cohort . RESULTS Thirty percent of the incident and 39 % of the prevalent patients presented signs of MA . Across worsening MA scale , nutritional and anthropometric markers of muscle loss were incrementally poorer . Inflammation markers as well as the proportion of women became progressively higher . Female sex , presence of cardiovascular disease , inflammation and low insulin-like growth factor-1 levels were associated with increased significant odd ratios of MA in each cohort . After adjustment for age , sex , inflammation , diabetes , cardiovascular disease , glomerular filtration rate and /or time on hemodialysis , the hazard ratio of death for moderate/severe MA was 2.62 ( 95 % CI : 1.34 , 5.13 ; p=0.001 ) and 3.04 ( 95 % CI : 1.61 , 5.71 ; p=0.0001 ) in the incident and prevalent cohorts respectively . CONCLUSION Increased MA is more common in female dialysis patients and associated with inflammation , poor nutritional and anthropometric status , as well as a 3-fold increased 4 - 6 year mortality . Our data support the use of frequent MA and /or nutritional assessment s in the clinical practice Left ventricular hypertrophy ( LVH ) and inflammation independently increase risk for death in people who receive hemodialysis .  A nonr and omized , controlled trial was conducted of the effect of short daily ( 6 sessions/wk of 3 h each ) or conventional ( three sessions/wk of 4 h each ) hemodialysis on LVH and inflammatory factors . A total of 26 short daily hemodialysis and 51 matched conventional hemodialysis patients were enrolled , and baseline and 12-mo measures of echocardiographic left ventricular mass index ( LVMI ) , serum C-reactive protein ( CRP ) , serum calcium and phosphorus , and erythropoietin resistance index were collected . Baseline characteristics were similar between groups except that hemoglobin and serum calcium were lower and serum phosphorus was higher in the short daily hemodialysis group . At 12-mo follow-up , short daily hemodialysis patients experienced a 30 % decrease in LVMI ( 154 + /- 33 to 108 + /- 25 ; P < 0.0001 ) . After adjustment for potential confounders , short daily hemodialysis ( beta = -41.63 , P = 0.03 ) and percentage decrease in serum phosphorus ( beta = -0.12 , P = 0.04 ) predicted a 12-mo decrease in LVMI . Among short daily hemodialysis patients , there were significant reductions in median CRP levels [ 1.22 interquartile range ( IQR ) ( 0.37 to 3.70 ) to 0.05 IQR ( 0.05 to 1.17 ) ; P < 0.01 ] and erythropoietin resistance index [ 19.5 IQR ( 8.6 to 37.6 ) to 10.5 IQR ( 5.5 to 14.6 ) ; P < 0.001 ] . There were no significant changes in LVMI , CRP , or erythropoietin resistance index in the conventional hemodialysis group . Short daily hemodialysis is associated with improved fluid and phosphorus management and a reduction in LVH and inflammatory factors compared with conventional hemodialysis . Future trials are needed to determine whether short daily hemodialysis can reduce morbidity and mortality in this high-risk population The object of this article was to determine the predictive value of risk factors for recurrent falls and the construction of a fall risk model as a contribution to a mobility assessment for the identification of community-dwelling elderly at risk for recurrent falling in general practice . The design was a prospect i ve cohort study ( n = 311 ) . There were four primary health care centers . A sample stratified on previous falls , age , and gender of community-dwelling elderly persons aged 70 years or over ( n = 311 ) was taken from the respondents to a mail question naire ( n = 1660 ) . They were visited at home to assess physical and mental health , balance and gait , mobility and strength . A 36-week follow-up with telephone calls every 6 weeks was conducted . Falls and fall injuries were measured . During follow-up 197 falls were reported by 33 % of the participants : one fall by 17 % and two or more falls by 16 % . Injury due to a fall was reported by 45 % of the fallers : 2 % hip fractures , 4 % other fractures , and 39 % minor injuries . A fall risk model for the prediction of recurrent falls with an area under the curve ( AUC ) of 0.79 , based on logistic regression analysis , showed that the main determinants for recurrent falls were : an abnormal postural sway ( OR 3.9 ; 95 % Cl 1.3 - 12.1 ) , two or more falls in the previous year ( OR 3.1 ; 95 % Cl 1.5 - 6.7 ) , low scores for h and grip strength ( OR 3.1 ; 95 % Cl 1.5 - 6.6 ) , and a depressive state of mind ( OR 2.2 ; 95 % CI 1.1 - 4.5 ) . To facilitate the use of the model for clinical practice , the model was converted to a " desk model " with three risk categories : low risk ( 0 - 1 predictor ) , moderate risk ( two predictors ) , and high risk ( > or =3 predictors ) . A fall risk model converted to a " desk model , " consisting of the predictors postural sway , fall history , h and dynamometry , and depression , provides added value in the identification of community-dwelling elderly at risk for recurrent falling and facilitates the prediction of recurrent falls OBJECTIVE To assess the usefulness of Duruöz 's H and Index ( DHI ) in patients undergoing haemodialysis . METHODS Patients receiving haemodialysis for more than 2 months were recruited r and omly . Demographic , clinical and functional characteristics of patients were evaluated . Functional assessment was performed with  DHI , H and Functional Index ( HFI ) ,  Health Assessment Question naire ( HAQ ) ,  Purdue Pegboard  , grip strength and 3 kinds of pinch strengths . DHI was correlated ( Spearman 's ) with the other functional parameters in assessing the convergent validity and with non-functional parameters in assessing the divergent validity . RESULTS Sixty patients with a mean age of 50.05 were recruited . The average duration of haemodialysis was 55.02 months . DHI is significantly correlated with HAQ , HFI , Purdue Pegboard scores , grip strength and 3 types of pinch strengths while no significant correlation was found with non-functional parameters . CONCLUSIONS DHI is a practical scale which is efficient in assessing accurately the functional disability of the h and in patients receiving haemodialysis 
    Output:
    
The analysed studies showed correlation between muscle function estimated by HGS and variables used in the assessment of muscle mass and nutritional status , as well as the prediction of clinical complications .
CONCLUSIONS The analysis indicates that HGS is a useful tool for continuous and systematic assessment of muscle mass related to nutritional status in patients on dialysis .