***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: The London Daily/Nocturnal  Hemodialysis  Study , a prospect i ve , comparative , nonr and omized study , directly compared outcomes of  quotidian ( daily ) hemodialysis patients with conventional thrice-weekly hemodialysis patients . Patients were assigned to either daily ( short-hours ) hemodialysis ( n = 11 ) or nocturnal hemodialysis ( n = 12 ) and followed up for 5 - 36 months ; all data were directly compared with matched control patients receiving conventional hemodialysis ( n = 22 ) . Outcomes evaluated were adequacy ( urea kinetics ) , nutrition , anemia management , blood pressure and volume control , calcium/phosphorus control , and patient quality of life . In addition , a detailed economic analysis was undertaken . The study showed that both quotidian hemodialysis regimens are more effective than conventional hemodialysis in improving weekly urea clearance . Significant clinical improvements were seen with quotidian therapy in the areas of nutrition ( short-hours daily ) , blood pressure ( both ) , volume control ( short-hours daily ) , calcium/phosphorus control ( nocturnal ) , and quality of life ( both ) . A nonsignificant trend for improvement in anemia management was suggested . The economic analysis showed substantial savings in annualized cost per quality -adjusted life-year in changing from conventional hemodialysis ( carried out in-center , in satellite units , or at home ) to home quotidian hemodialysis . The substantial clinical benefits of home quotidian hemodialysis , combined with the economic advantage shown by this study , clearly justify its expansion . ( The details of this study have recently been published in 11 articles in the American Journal of Kidney Diseases[2003;42(suppl 1 ) ] Observational studies suggest improvements with  frequent hemodialysis ( HD )  , but its true efficacy and safety remain uncertain . The Frequent Hemodialysis Network Trials Group is conducting two multicenter r and omized trials of 250 subjects each , comparing conventional three times weekly  HD with ( 1 ) in-center daily HD and ( 2 ) home nocturnal HD . Daily HD will be delivered for 1.5 - 2.75 h , 6 days/week , with target eK(t)/V(n ) > or = 0.9/session , whereas nocturnal HD will be delivered for > or = 6 h , 6 nights/week , with target stdK(t)/V of > or = 4.0/week . Subjects will be followed for 1 year . The composite of mortality with the 12-month change in ( i ) left ventricular mass index ( LVMI ) by magnetic resonance imaging , and ( ii ) SF-36 R AND Physical Health Composite ( PHC ) are specified as co- primary outcomes . The seven main secondary outcomes are between group comparisons of : change in LVMI , change in PHC , change in Beck Depression Inventory score , change in Trail Making Test B score , change in pre-HD serum albumin , change in pre-HD serum phosphorus , and rates of non-access hospitalization or death . Changes in blood pressure and erythropoiesis will also be assessed . Safety outcomes will focus on vascular access complications and burden of treatment . Data will be obtained on the cost of delivering frequent HD compared to conventional HD . Efforts will be made to reduce bias , including blinding assessment of subjective outcomes . Because no large-scale r and omized trials of frequent HD have been previously conducted , the first year has been design ated a Vanguard Phase , during which feasibility of r and omization , ability to deliver the interventions , and adherence will be evaluated 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 Care of patients with end-stage renal disease ( ESRD ) is important and re source intense . To enable ESRD programs to develop strategies for more cost-efficient care , an accurate estimate of the cost of caring for patients with ESRD is needed . METHODS The objective of our study is to develop an up date d and accurate itemized description of costs and re sources required to treat patients with ESRD on dialysis therapy  and contrast differences in re sources required for various dialysis modalities . One hundred sixty-six patients who had been on dialysis therapy for longer than 6 months and agreed to enrollment were followed up prospect ively for 1 year . Detailed information on baseline patient characteristics , including comorbidity , was collected . Costs considered included those related to outpatient dialysis care , inpatient care , outpatient nondialysis care , and physician cl aims . We also estimated separately the cost of maintaining the dialysis access .  RESULTS Overall annual cost of care for in-center , satellite , and home/self-care hemodialysis and peritoneal dialysis  were US $ 51,252 ( 95 % confidence interval [ CI ] , 47,680 to 54,824 ) , $ 42,057 ( 95 % CI , 39,523 to 44,592 ) , $ 29,961 ( 95 % CI , 21,252 to 38,670 ) , and $ 26,959 ( 95 % CI , 23,500 to 30,416 ) , respectively ( P < 0.001 ) . After adjustment for the effect of other important predictors of cost , such as comorbidity , these differences persisted . Among patients treated with  hemodialysis  , the cost of vascular access-related care was lower by more than fivefold for patients who began the study period with a functioning native arteriovenous fistula compared with those treated with a permanent catheter or synthetic graft ( P < 0.001 ) . CONCLUSION To maximize the efficiency with which care is provided to patients with ESRD , dialysis programs should encourage the use of home/self-care hemodialysis and peritoneal dialysis BACKGROUND Home nocturnal hemodialysis ( HNHD )  can improve clinical and biochemical factors in people with renal failure , but its cost-effectiveness relative to conventional in-center hemodialysis ( IHD ) is uncertain . We hypothesized that HNHD would provide more dialysis treatments at a lower total cost than IHD . METHODS A prospect i ve one-year descriptive costing study was performed at two centers in Toronto , Canada , involving patients enrolled from a HNHD program ( N = 33 ) , and a matched cohort from an IHD program ( N = 23 ) . All costs are expressed as mean weekly amount in Canadian year 2000 dollars . A projected mean annual cost ( PMA ) was calculated also . RESULTS The mean number of treatments per week was much higher with HNHD ( 5.7 vs. 3.0 , P = 0.004 ) . Cost categories found to be less expensive for HNHD were staffing ( weekly $ 210 vs. $ 423 , P < 0.001 , PMA $ 10,932 vs. $ 22,056 ) and overhead and support ( weekly $ 80 vs. $ 238 , P < 0.001 , PMA $ 4179 vs. $ 12,393 ) . There was a trend toward lower costs for hospital admissions and procedures ( weekly $ 23 vs. $ 134 , P = 0.355 , PMA $ 1173 vs. $ 6997 ) and for medications ( $ 172 vs. $ 231 , P = 0.082 , PMA $ 8989 vs. $ 12,029 ) . Costs found to be more expensive for HNHD were the cost of direct hemodialysis material s ( weekly $ 318 vs. $ 126 , P < 0.001 , PMA $ 16,587 vs. $ 6575 ) and capital costs ( weekly $ 118 vs. $ 17 , P < 0.001 , PMA $ 6139 vs. $ 871 ) , with a trend toward higher cost for laboratory tests ( weekly $ 33 vs. $ 26 , P = 0.094 , PMA $ 1744 vs. $ 1364 ) . Physician costs were the same at $ 128 per week ( PMA $ 6650 ) . The weekly mean total cost for health care delivery was 20 % less for HNHD ( $ 1082 vs. $ 1322 , P = 0.006 ) , with projected mean annual costs more than $ 10,000 lower ( $ 56,394 vs. $ 68,935 ) . CONCLUSIONS HNHD provides about three times as many treatment hours at nearly a one-fifth lower cost , with savings evident even when only program and funding -specific costs are considered 
    Output:
    
The higher costs of  frequent  compared to conventional home hemodialysis  were because of higher consumable usage due to dialysis frequency .
Thus , our findings reinforce the conclusions of previous studies showing that home-based conventional and more frequent hemodialysis may provide clinical benefit at reasonable costs