***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 Chronic sub clinical volume overload occurs very frequently and may be ubiquitous in hemodialysis ( HD ) patients receiving the st and ard thrice-weekly treatment . It is directly associated with hypertension , increased arterial stiffness , left ventricular hipertrophy , heart failure , and eventually , higher mortality and morbidity . We aim ed to assess for the first time if the relationship between bioimpedance assessed overhydration and survival is maintained when adjustments for echocardiographic parameters are considered . Design , setting , participants and measurements A prospect i ve cohort trial was conducted to investigate the impact of overhydration on all cause mortality and cardiovascular events ( CVE ) , by using a previously reported cut-off value for overhydration and also investigating a new cut-off value derived from our analysis of this specific cohort . The body composition of 221 HD patients from a single center was assessed at baseline using bioimpedance .  In 157 patients supplemental echocardiography was performed ( echocardiography subgroup ) . Comparative survival analysis was performed using two cut-off points for relative fluid overload ( RFO ) : 15 % and 17.4 % ( a value determined by statistical analysis to have the best predictive value for mortality in our cohort ) . Results In the entire study population , patients considered overhydrated ( using both cut-offs ) had a significant increased risk for all-cause mortality in both univariate ( HR = 2.12 , 95%CI = 1.30–3.47 for RFO>15 % and HR = 2.86 , 95%CI = 1.72–4.78 for RFO>17.4 % , respectively ) and multivariate ( HR = 1.87 , 95%CI = 1.12–3.13 for RFO>15 % and HR = 2.72 , 95%CI = 1.60–4.63 for RFO>17.4 % , respectively ) Cox survival analysis . In the echocardiography subgroup , only the 17.4 % cut-off remained associated with the outcome after adjustment for different echocardiographic parameters in the multivariate survival analysis . The number of CVE was significantly higher in overhydrated patients in both univariate ( HR = 2.46 , 95%CI = 1.56–3.87 for RFO > 15 % and HR = 3.67 , 95%CI = 2.29–5.89 for RFO > 17.4 % ) and multivariate ( HR = 2.31 , 95%CI = 1.42–3.77 for RFO > 15 % and HR = 4.17 , 95%CI = 2.48–7.02 for RFO > 17.4 % ) Cox regression analysis . Conclusions The study shows that the hydration status is associated with the mortality risk in a HD population , independently of cardiac morphology and function . We also describe and propose a new cut-off for RFO , in order to better define the relationship between overhydration and mortality risk . Further studies are needed to properly vali date this new cut-off in other HD population BACKGROUND AND OBJECTIVES Hypervolemia is a major concern in dialysis patients , and is associated with increased cardiovascular risk and death . Cross sectional analysis have previously demonstrated that  peritoneal dialysis ( PD ) patients are not more overhydrated when compared to haemodialysiś ones . This study was design ed to evaluate longitudinal trends in hydration status and corporal composition in a PD population . METHODS We conducted a 2 year prospect i ve observational study of 58 PD patients from a single centre . Incident and prevalent patients were included . Yearly measurements were performed using multifrequency electric bioimpedance . Overhydration ( OH ) was defined as an extra-cellular water (ECW)/total body water ( TBW ) over 15 % . Clinical and biochemical variables were also explored . RESULTS A total of 30 patients completed evaluation ( female 63.3 % , mean age 56.9 years , BMI 25.0 kg/m² , diabetes 10.0 % , APD-50.0 % ) . Median PD vintage was 21.9 months , and 36.7 % were anuric . At baseline 6.7 % were overhydrated . On longitudinal analysis no significant changes were found in hydration status , systolic blood pressure , pro-BNP , nor albumin levels . Similar results were found among incident ( n=11 ; APD- 45.5 % ; anuric- 9.1 % ) and prevalent ( n=19 ; APD- 52.6 % ; anuric- 52.6 % ) patients ( p>.05 ) . However , at the second year , prevalent patients were moderately overhydrated compared to incident ones ( median 10.2 % vs 3.5 % ; p=.009 ) . Nonetheless , no statistical difference was observed considering adequacy , TBW , or ECW . Moreover , nutritional parameters remained stable . CONCLUSIONS Peritoneal dialysis maintenance without increasing volume status , nor major deleterious corporal composition trends , is feasible under careful therapy strategies . Longitudinal application of BIA may be a useful clinical tool to evaluate adequacy beyond Mounting evidence supports a strong association between fluid management and outcomes among individuals receiving maintenance hemodialysis . The speed of fluid removal during dialysis ( ultrafiltration , UF ) is a modifiable aspect of fluid management that has attracted recent attention as a potential performance measure for facility fluid management practice s. Observational data support an association between higher UF rates and adverse outcomes . This association is supported by the plausible pathophysiologic rationale of hypoperfusion-induced ischemic injury to the heart and other end-organs . However , no published clinical trial has studied the impact of lowering UF rates on clinical and patient-centered outcomes . Lowering UF rates requires interdialytic weigh gain reduction and /or extension of dialysis time . Weight gain reduction has proven difficult despite nutritional programs focused on salt and fluid restrictions , and patients are generally averse to longer treatment times . Thus , imposition of UF rate limitations may lead to failed target weight achievement and volume expansion over time . Despite these potential unintended consequences , the National Quality Forum endorsed an UF rate clinical performance measure in 2015 . Prior to implementation of quality measure-imposed UF rate limitations , prospect i ve studies of UF rates and outcomes are needed BACKGROUND AND OBJECTIVES Achieving and maintaining optimal fluid status remains a major challenge in hemodialysis therapy . The aim of this interventional study was to assess the feasibility and clinical consequences of active fluid management guided by bioimpedance spectroscopy in chronic hemodialysis patients . DESIGN , SETTING , PARTICIPANTS , & MEASUREMENTS Fluid status was optimized prospect ively in 55 chronic hemodialysis patients over 3 months ( November 2011 to February 2012 ) . Predialysis fluid overload was measured weekly using the Fresenius Body Composition Monitor . Time-averaged fluid overload was calculated as the average between pre- and postdialysis fluid overload . The study aim ed to bring the time-averaged fluid overload of all patients into a target range of 0.5 ± 0.75 L within the first month and maintain optimal fluid status until study end . Postweight was adjusted weekly according to a predefined protocol . RESULTS Time-averaged fluid overload in the complete study cohort was 0.9 ± 1.6 L at baseline and 0.6 ± 1.1 L at study end . Time-averaged fluid overload decreased by -1.20 ± 1.32 L ( P<0.01 ) in the fluid-overloaded group ( n=17 ) , remained unchanged in the normovolemic group ( n=26 , P=0.59 ) , and increased by 0.59 ± 0.76 L ( P=0.02 ) in the dehydrated group ( n=12 ) . Every 1 L change in fluid overload was accompanied by a 9.9 mmHg/L change in predialysis systolic BP ( r=0.55 , P<0.001 ) . At study end , 76 % of all patients were either on time-averaged fluid overload target or at least closer to target than at study start . The number of intradialytic symptoms did not change significantly in any of the subgroups . CONCLUSIONS Active fluid management guided by bioimpedance spectroscopy was associated with an improvement in overall fluid status and BP Purpose Fluid management with body composition monitor based on bioimpedance spectroscopy ( BCM-BIS ) has been found to be beneficial for dialysis patients . We conducted a study to provide an algorithm for the determination of post-dialysis target weight ( PDTW ) and to evaluate whether this approach could improve clinical outcomes compared to patients who had PDTW decided clinical ly . Methods Two hundred and ninety-eight dialysis patients participated in this 1-year r and omized controlled trial . The outcomes were all-cause hospitalization rate , AFO or CV-related events , hypertension and intra-dialysis morbidities . Results 80 % of post-dialysis weight reached the target set with current algorithm . All-cause hospitalization rate was not different . Incidence of acute fluid overload ( AFO ) or CV-related events was lower in study group . Longitudinal data showed decreased incidence of hypertension , intra-dialysis morbidities and intra-dialysis hypotension . Conclusions Assessment of PDTW by BCM-BIS with an explicit algorithm decreased AFO or CV-related events , hypertension and intra-dialysis morbidities . Further studies were required to demonstrate possible benefits of hospitalization rate Background : Fluid status is an independent predictor of mortality in dialysis patients . Current methods of fluid assessment have several limitations . Summary : An ideal method should be cheap , portable , easy to perform without extensive training , reproducible and determines patients ' excess or deficit of total body water . Bioimpedance analysis ( BIA ) fulfils many of these criteria and can give additional information on fat and lean tissue composition . The accuracy and precision of BIA has been shown to be equivalent to the ‘ gold st and ard ' direct estimation techniques . Key Messages : Although there remains some concern about its validity in dialysis patients , fluid overload determined by BIA has been shown to predict mortality . BIA-guided fluid management appears superior to conventional fluid management in achieving clinical ly important outcomes such as reduction in blood pressure , left ventricular mass index , and arterial stiffness . Accurate setting of dry weight might also help preserve residual renal function by limiting episodes of dehydration . Nevertheless , as with all new technologies , there are issues that still need to be resolved . This will be achieved only with larger prospect i ve interventional studies to explore its specific roles in dialysis cohorts ♦ Background : Hospitalization rates are a relevant consideration when choosing or recommending a dialysis modality . Previous comparisons of peritoneal dialysis ( PD ) and hemodialysis ( HD ) have not been restricted to individuals who were eligible for both therapies . ♦ Methods : We conducted a multicenter prospect i ve cohort study of people 18 years of age and older who were eligible for both PD and HD , and who started outpatient dialysis between 2007 and 2010 in four Canadian dialysis programs . Zero-inflated negative binomial models , adjusted for baseline patient characteristics , were used to examine the association between modality choice and rates of hospitalization . ♦ Results : The study enrolled 314 patients . A trend in the HD group toward higher rates of hospitalization , observed in the primary analysis , became significant when modality was treated as a time-varying exposure or when the population was restricted to elective outpatient starts in patients with at least 4 months of pre-dialysis care . Cardiovascular disease , infectious complications , and elective surgery were the most common reasons for hospital admission ; only 23 % of hospital stays were directly related to complications of dialysis or kidney disease . ♦ Conclusions : Efforts to promote PD utilization are unlikely to result in increased rates of hospitalization , and efforts to reduce hospital admissions should focus on potentially avoidable causes of cardiovascular disease and infectious complications Background Lung ultrasound is a novel technique for detecting generalized fluid overload in children and adults with end-stage renal disease ( ESRD ) . Echocardiography and bioimpedance spectroscopy are established methods , albeit variably adopted in clinical practice . We compared the practicality and accuracy of lung ultrasound with current objective techniques for detecting fluid overload in children with ESRD . Methods A prospect i ve observational study was performed to compare lung ultrasound B-lines , echocardiographic measurement of inferior vena cava parameters and bioimpedance spectroscopy in the assessment of fluid overload in children with ESRD on dialysis . The utility of each technique in predicting fluid overload , based on short-term weight gain , was assessed . Multiple linear regression models to predict fluid overload by weight were explored . Results A total of 22 fluid assessment s were performed in 13 children ( 8 on peritoneal dialysis , 5 on haemodialysis ) with a median age of 4.0 ( range 0.8–14.0 ) years . A significant linear correlation was observed between the number of B-lines detected by  lung ultrasound and fluid overload by weight ( r = 0.57 , p = 0.005 ) . A non-significant positive linear correlation was observed between fluid overload by weight and bioimpedance spectroscopy ( r = 0.43 , p = 0.2 ) , systolic blood pressure ( r = 0.19 , p = 0.4 ) and physical examination measurements ( r = 0.19 , p = 0.4 ) , while a non-significant negative linear relationship was found between the inferior vena cava collapsibility index and fluid overload by weight ( 
    Output:
    
BCM used in addition to clinical assessment may lower overhydration and potentially improve intermediate outcomes , such as SBP , but effects on mortality have not been demonstrated .
If dialysis costs are not considered , the incremental cost-effectiveness ratio falls below £ 20,000 , with modest effects on mortality and /or hospitalisation rates .
The current findings are not generalisable to paediatric population s nor across other multifrequency bioimpedance devices .