***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: In a prospect i ve cohort study , we constructed a composite index of poor outcome that incorporates survival , morbidity , and quality of life ( QL ) . We identified baseline patient and treatment characteristics that predicted poor outcome 1 year after the start of  chronic dialysis .  Outcome was classified as poor if a patient had died or if at least two of the following criteria were present : ( 1 ) 30 days or greater of hospitalization per year , ( 2 ) serum albumin level of 30 g/L or less or a malnutrition index score of 11 or greater , ( 3 ) a 36-item Medical Outcomes Study (MOS)-Short Form Health Survey Question naire ( SF-36  ) physical summary QL score of 2 or more SDs less than the general population mean score , and ( 4 ) an SF-36 mental summary QL score of 2 or more SDs less than the general population mean score . Multivariate logistic regression analysis was used to identify independent predictors of poor outcome . Of 250 included patients , 189 were assessable with respect to poor outcome . Of these patients , 47 ( 25 % ) were classified as poor . A baseline presence of comorbidity , serum albumin level of 30 g/L or less , physical or mental QL score 2 or more SDs less than the general population mean score , and , to a lesser extent , residual glomerular filtration rate of 2.5 mL/min/1.73 m(2 ) or less were independently associated with a greater risk for poor outcome . A post hoc analysis indicated a mean arterial blood pressure greater than 107 mm Hg was predictive of poor outcome in patients undergoing peritoneal dialysis .  In conclusion , our prognostic model provides a useful tool to identify  chronic dialysis patients at risk for poor health status . Strategies aim ed at preserving residual renal function , controlling blood pressure , monitoring QL , and consequently giving psychosocial support may reduce the risk for poor outcome Objective The goals for maintenance dialysis treatment are to improve patient survival , reduce patient morbidity , and improve patient quality of life . This is the first r and omized prospect i ve study comparing automated peritoneal dialysis ( APD ) and continuous ambulatory peritoneal dialysis ( CAPD ) treatment with respect to quality of life and clinical outcomes in relation to therapy costs . Design A prospect i ve , r and omized multicenter study . Setting Three Danish CAPD units . Patients Thirty-four adequately dialyzed patients with high or high-average peritoneal transport characteristics were included in the study . Twenty-five patients completed the study . Interventions After r and omization , 17 patients were allocated to APD treatment  and 17 patients to CAPD treatment for a period of 6 months . Medical and biochemical parameters were evaluated at monthly controls in the CAPD units . Quality -of-life parameters were assessed at baseline and after 6 months by the self-administered short-form SF-36 generic health survey question naire supplemented with disease- and treatment-specific questions . Therapy costs were compared by evaluating dialysis-related expenses . Main Outcome Measures Quality -of-life parameters , dialysis-related complications , dialysis-related expenses . Results The quality -of-life studies showed that significantly more time for work , family , and social activities was available to patients on APD compared to those on CAPD ( p < 0.001 ) . Although the difference was not significant , there was a tendency for less physical and emotional discomfort caused by dialysis fluid in the APD group . Sleep problems , on the other h and , tended to be more marked in the APD group . Any positive effect of APD compared to CAPD on dialysis-related hospital days or complication rates could not be confirmed . With larger patient sample s , it is possible , however , that a significant difference might have been achieved . The running costs for APD treatment were US $ 75 per day and for CAPD treatment US $ 61 per day . Conclusion If APD treatment can help to keep selected patients vocationally or socially active , paying the extra cost seems reasonable BACKGROUND Intravenous ascorbic acid ( IVAA ) administration is reported to enhance erythropoiesis in hemodialysis ( HD ) patients with functional iron deficiency . We explored the effects of IVAA on erythropoiesis and health-related quality of life ( HRQOL ) in unselected HD patients . METHODS Sixty-one HD patients were divided into two groups ; 30 patients received 100 mg of IVAA ( IVAA group ) and 31 patients did not ( control group ) after each dialysis session . Hematocrit ( Hct ) , reticulocyte hemoglobin content , transferrin saturation , ferritin , weekly recombinant human erythropoietin ( rHuEPO ) dosage , weekly intravenous iron ( IVFE ) dosage , and MOS Short Form 36 ( SF-36 ) scale scores were measured at baseline and after 6 months of treatment . RESULTS Mean changes in Hct in the IVAA and control groups were -0.5 and -0.6 mg/dL , respectively , while mean changes in SF-36 scale scores were : physical functioning -1.6 in the IVAA group and 0.38 in the controls ; role physical ( RP ) 3.8 and 9.4 ; bodily pain 9.7 and 0.81 ; general health perception 3.7 and -0.68 ; vitality 4.3 and -7.5 ; social functioning 2.7 and 0.43 ; role emotional ( RE ) 6.9 and 4.9 ; mental health 3.6 and -1.7 . The IVAA group showed significantly higher adverse events ( chest pain : n=1 , nausea : n=2 and fatigue : n=2 ) compared to the controls ( no event ) . CONCLUSIONS The beneficial effects of IVAA on erythropoiesis and HRQOL were not demonstrated in unselected HD patients . Indication of IVAA for HD patients leaves room for further study BACKGROUND Socioeconomic status ( SES ) has been associated with the incidence of end-stage renal disease ( ESRD ) ; however , the impact of SES on the quality of life ( QOL ) of these patients has not been clearly defined . METHODS One hundred eighteen patients were prospect ively evaluated at the beginning of dialysis treatment and reassessed ( n = 90 ) after an average of 7 months . QOL was measured by means of the Medical Outcomes Survey 36-Item Short Form ( SF-36 ) . Classification of SES was according to vali date d criteria of the Brazilian Association of Research Institutes . RESULTS Mean scores for SF-36 dimensions were decreased in patients with low compared with high SES , with greater differences noted during follow-up . At this time , mean scores for SF-36 scales for the low- and high-SES groups were as follows : Functional Capacity , 43 + /- 31 versus 68 + /- 26 ( P < 0.01 ) ; Physical Aspect , 34 + /- 36 versus 56 + /- 38 ; Pain , 55 + /- 31 versus 80 + /- 28 ( P < 0.01 ) ; General Health Status , 60 + /- 21 versus 67 + /- 19 ; Vitality , 42 + /- 25 versus 59 + /- 16 ( P < 0.05 ) ; Social Aspect , 53 + /- 32 versus 81 + /- 21 ( P < 0.01 ) ; Emotional Aspect , 49 + /- 44 versus 70 + /- 41 ; and Mental Health , 51 + /- 27 versus 70 + /- 22 ( P < 0.05 ) , respectively . These differences were more pronounced than expected for an age- and sex-matched sample of the Brazilian general population . Multivariate analysis showed that SES continued to significantly affect all QOL dimensions , explaining 5.5 % to 14.1 % of variation in scales . CONCLUSION SES is an important factor associated with QOL in patients with ESRD . Further studies to determine optimum interventions and measures in groups with lower SES may be important to improve QOL outcomes and reduce their morbidity BACKGROUND Health-related quality of life may affect morbidity and survival in end-stage renal disease , but it is not clear whether coexisting comorbidity and other known prognostic variables could account for such an association . METHODS To study the relationship between  health-related quality of life  and morbidity and survival , we carried out an inception cohort study in patients starting chronic dialysis , mostly diabetics , with a follow-up of 1 - 3 years in 34 Spanish hospitals .  Health-related quality of life was measured by the SF-36 Health Survey and Karnofsky scale . Charlson age-comorbidity index and other prognostic clinical variables were measured concurrently . The primary outcome variable was time until death and the secondary outcome was hospitalization days . RESULTS Of 318 patients enrolled ( 208 diabetics ) , with a median follow-up of 771 days , 80 died . In the unadjusted analysis , all-cause mortality was associated with lower SF-36 physical and mental component scores and Karnofsky scale . In the adjusted analysis , SF-36 mental component score predicted all-cause mortality ( hazard ratio for a 10 point decrease : 1.28 ; 95 % confidence interval : 1.05 - 1.56 ) . The SF-36 mental component score also predicted more hospitalization days ( adjusted risk ratio of each additional hospital day associated with every 10 point decrease : 1.25 ; 95 % confidence interval : 1.08 - 1.45 ) . Among diabetics , both the SF-36 physical and mental components predicted mortality and hospitalization days . CONCLUSIONS In end-stage renal disease , perceived mental health is an independent predictor of mortality and morbidity , mainly among diabetics patients BACKGROUND We hypothesized that increasing small solute clearance in  peritoneal dialysis ( PD )  would lead to improvements in patient health-related quality of life ( HRQOL ) . METHODS Patients were r and omized to a control group [ st and ard 4 x 2 L continuous ambulatory peritoneal dialysis ( CAPD ) ] and an intervention group ( CAPD with a target creatinine clearance > /=60 L/week/1.73 m(2 ) ) . The Kidney Disease Quality of Life Short Form was obtained at baseline and at 6 , 12 , and 24 months . Physical ( PCS ) , mental ( MCS ) , and kidney disease component summary ( KDCS ) scores were computed . RESULTS The two groups were comparable at baseline with respect to HRQOL . Baseline variables highly predictive of better QOL included absence of diabetes , younger age , higher starting GFR , and serum albumin . Baseline values of QOL were highly predictive of survival and hospitalizations . An unadjusted comparison revealed that patients in the intervention group had significantly higher PCS and KDCS scores at six months . However , there were no significant differences between the intervention and control patients at 12 or 24 months . When similar analyses were carried out adjusting for different patterns of patient dropout , there were no significant differences between the two groups at any time point in terms of PCS , MCS , and KDCS scores . CONCLUSION We found no evidence of a long-term benefit in HRQOL of CAPD patients by increasing peritoneal small-solute clearances when HRQOL parameters were adjusted for patient dropout . Measures of HRQOL have a significant predictive value for patient survival and hospitalizations BACKGROUND It has been widely supposed that high dose and high flux hemodialysis would affect the quality as well as the length of life of patients treated by maintenance hemodialysis .  The HEMO Study examined changes in health-related quality of life as a secondary study outcome . Specific hypotheses were that study interventions would affect physical functioning , vitality , Short Form-36 Health Survey ( SF-36 ) physical and mental component summary scores , symptoms and problems associated with kidney disease , and sleep quality . METHODS At baseline and annually , subjects responded to both the Index of Well-Being and the Kidney Disease Quality of Life-Long Form question naires . The interventions were assessed on the basis of their average effects over 3 years . RESULTS At baseline , the SF-36 physical component summary score was lower than in healthy population s , but the mental component score was nearly normal . Over 3-year follow-up , physical health continued to decline ; mental health and kidney disease-targeted scores remained relatively stable . The high dose hemodialysis intervention was associated with significantly less pain ( 4.49 points , P < 0.001 ) and higher physical component scores ( 1.23 points P= 0.007 ) , but these effects were small compared to the natural variability in scores . High flux membranes were not associated with statistically significant differences in health-related quality of life . CONCLUSION The HEMO Study results demonstrate the marked burden of chronic kidney failure and hemodialysis treatment on daily life . In this trial among patients undergoing maintenance three times a week hemodialysis , the SF-36 physical component summary score and pain scale showed significant but very small clinical effects favoring the higher dialysis dose . No clinical ly meaningful benefits or either the dose or flux interventions were observed for other indices of health-related quality of life Background / Aims : Ideal dry weight ( DW ) can serve as a marker of good quality of life ( QOL ) in patients receiving chronic hemodialysis . The size of the inferior vena cava ( IVC ) reflects the intravascular fluid status , and the diameter of IVC correlates indirectly with DW in these patients . Adjusting DW using echocardiographic measurement of the diameter of the IVC thus may be useful in maintenance of a better QOL in patients receiving chronic hemodialysis . Methods : This study included 119 patients with ages ranging between 27 and 90 years ( mean ± st and ard deviation of 58.3 ±  
    Output:
    
The unadjusted scores of all SF-36 health dimensions were not significantly different between HD and PD patients , but the scores of RTx patients were higher than those of dialysis patients , except for the dimensions Mental Health and Bodily Pain .
The significance of the differences of both dialysis groups compared with RTx recipients disappeared for the dimensions Vitality and Social Functioning .
The significance of the differences between HD and RTx patients disappeared on the dimensions Physical Functioning , Role Physical , and Bodily Pain .
CONCLUSION We conclude that  dialysis patients have a lower quality of life than  RTx patients , but this difference can partly be explained by differences in age and prevalence of diabetes