***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 In this r and omized clinical trial , we aim ed to determine whether increasing the frequency of in-center hemodialysis would result in beneficial changes in left ventricular mass , self-reported physical health , and other intermediate outcomes among patients undergoing maintenance hemodialysis . METHODS Patients were r and omly assigned to undergo hemodialysis six times per week  ( frequent hemodialysis , 125 patients ) or three times per week  ( conventional hemodialysis , 120 patients ) for 12 months . The two co primary composite outcomes were death or change ( from baseline to 12 months ) in left ventricular mass , as assessed by cardiac magnetic resonance imaging , and death or change in the physical-health composite score of the R AND 36-item health survey . Secondary outcomes included cognitive performance ; self-reported depression ; laboratory markers of nutrition , mineral metabolism , and anemia ; blood pressure ; and rates of hospitalization and of interventions related to vascular access . RESULTS Patients in the frequent-hemodialysis group averaged 5.2 sessions per week ; the weekly st and ard Kt/V(urea ) ( the product of the urea clearance and the duration of the dialysis session normalized to the volume of distribution of urea ) was significantly higher in the frequent-hemodialysis group than in the conventional-hemodialysis group ( 3.54±0.56 vs. 2.49±0.27 ) . Frequent hemodialysis was associated with significant benefits with respect to both co primary composite outcomes ( hazard ratio for death or increase in left ventricular mass , 0.61 ; 95 % confidence interval [ CI ] , 0.46 to 0.82 ; hazard ratio for death or a decrease in the physical-health composite score , 0.70 ; 95 % CI , 0.53 to 0.92 ) . Patients r and omly assigned to frequent hemodialysis were more likely to undergo interventions related to vascular access than were patients assigned to conventional hemodialysis ( hazard ratio , 1.71 ; 95 % CI , 1.08 to 2.73 ) . Frequent hemodialysis was associated with improved control of hypertension and hyperphosphatemia . There were no significant effects of frequent hemodialysis  on cognitive performance , self-reported depression , serum albumin concentration , or use of erythropoiesis-stimulating agents . CONCLUSIONS Frequent hemodialysis , as compared with conventional hemodialysis , was associated with favorable results with respect to the composite outcomes of death or change in left ventricular mass and death or change in a physical-health composite score but prompted more frequent interventions related to vascular access . ( Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others ; Clinical Trials.gov number , NCT00264758 . ) CONTEXT Morbidity and mortality rates in hemodialysis patients remain excessive . Alterations in the delivery of dialysis may lead to improved patient outcomes . OBJECTIVE To compare the effects of frequent nocturnal hemodialysis vs conventional hemodialysis on change in left ventricular mass and health-related quality of life over 6 months . DESIGN , SETTING , AND PARTICIPANTS A 2-group , parallel , r and omized controlled trial conducted at 2 Canadian university centers between August 2004 and December 2006 . A total of 52 patients undergoing hemodialysis were recruited . INTERVENTION Participants were r and omly assigned in a 1:1 ratio to receive nocturnal hemodialysis 6 times weekly or conventional hemodialysis 3 times weekly . MAIN OUTCOME MEASURES The primary outcome was change in left ventricular mass , as measured by cardiovascular magnetic resonance imaging . The secondary outcomes were patient-reported quality of life , blood pressure , mineral metabolism , and use of medications . RESULTS Frequent nocturnal hemodialysis significantly improved the primary outcome ( mean left ventricular mass difference between groups , 15.3 g , 95 % confidence interval [ CI ] , 1.0 to 29.6 g ; P = .04 ) . Frequent nocturnal hemodialysis did not significantly improve quality of life ( difference of change in EuroQol 5-D index from baseline , 0.05 ; 95 % CI , -0.07 to 0.17 ; P = .43 ) . However , frequent nocturnal hemodialysis was associated with clinical ly and statistically significant improvements in selected kidney-specific domains of quality of life ( P = .01 for effects of kidney disease and P = .02 for burden of kidney disease ) . Frequent nocturnal hemodialysis was also associated with improvements in systolic blood pressure ( P = .01 after adjustment ) and mineral metabolism , including a reduction in or discontinuation of antihypertensive medications ( 16/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional hemodialysis group ; P < .001 ) and oral phosphate binders ( 19/26 patients in the nocturnal hemodialysis group vs 3/25 patients in the conventional dialysis group ; P < .001 ) . No benefit in anemia management was seen with nocturnal hemodialysis . CONCLUSION This preliminary study revealed that , compared with conventional hemodialysis ( 3 times weekly ) , frequent nocturnal hemodialysis improved left ventricular mass , reduced the need for blood pressure medications , improved some measures of mineral metabolism , and improved selected measures of quality of life . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N25858715 BACKGROUND Using st and ard hemodialysis regimens , overweight patients often do not reach Kidney Disease Outcomes Quality Initiatives ( KDOQI ) Kt/V targets , and this has been associated with lower health-related quality of life ( HRQL ) . Whether increasing dialysis adequacy in large patients not achieving KDOQI targets improves HRQL is unknown . STUDY DESIGN R and omized blinded crossover study . SETTING & PARTICIPANTS Overweight ( > 80 kg ) underdialyzed patients from 6 dialysis units in 2 Canadian dialysis programs . INTERVENTIONS Six-week treatment periods with a st and ard dialysis regimen ( 4 hours 3 times weekly ) and 3 augmented regimens : 4.5 hours of hemodialysis , 4 hours of hemodialysis with increased dialysate flow , and 4 hours of hemodialysis with 2 dialyzers in parallel . OUTCOMES & MEASUREMENTS The End-Stage Renal Disease Symptom domain of the Kidney Disease Quality -of-Life Short-Form question naire ( primary outcome ) and the Health Utilities Index Mark 2 ( secondary outcome ) . RESULTS We enrolled 18 patients ( mean weight , 109.7 + /- 16.2 [ SD ] kg ) ; 12 completed all 4 regimens .  Mean Kt/Vs during the study were 1.27 ( 95 % confidence interval [ CI ] , 1.19 to 1.35 ) , 1.41 ( 95 % CI , 1.32 to 1.50 ) , 1.31 ( 95 % CI , 1.22 to 1.39 ) , and 1.41 ( 95 % CI , 1.33 to 1.49 ) for patients receiving st and ard dialysis , 4.5 hours of hemodialysis , hemodialysis with increased dialysate flow , and hemodialysis with 2 dialyzers , respectively . Kidney Disease Quality -of-Life End-Stage Renal Disease Symptom domain and Health Utilities Index Mark 2 scores were 75.9 ( 95 % CI , 70.7 to 81.2 ) and 0.69 ( 95 % CI , 0.56 to 0.81 ) for patients receiving st and ard dialysis , respectively . These did not differ when patients received the 3 augmented dialysis regimens ( P = 0.2 and P = 0.5 , respectively ) . LIMITATIONS Small sample size and inability to fully blind patients to the treatment they were receiving . CONCLUSION Improving hemodialysis adequacy for large underdialyzed patients did not lead to improved HRQL . Our findings suggest that augmentation of the dialysis regimen is not required for these patients in the absence of overt uremic symptoms BACKGROUND Despite the growing interest in more frequent hemodialysis ( HD ) , to date , there have been no r and omized prospect i ve studies comparing outcomes in patients dialyzed using conventional thrice-weekly therapy with either the short hours daily or long slow nocturnal HD modalities . METHODS The London Daily/Nocturnal Hemodialysis Study , a prospect i ve , comparative , nonr and omized study , directly compared outcomes of  quotidian HD patients with conventional thrice-weekly HD patients . Patients were assigned to either daily HD ( n = 11 ) or nocturnal HD ( n = 12 ) and followed up for 5 to 36 months ; all data were directly compared with matched control patients receiving conventional HD . This report describes the study design , morbidity and mortality results , and vascular access results . RESULTS There were no significant differences between patient groups in total numbers of hospital admissions or hospital days . Likewise , there was no significant difference in number of emergency visits per patient-year . There were 3 patient deaths in each of the nocturnal HD and control groups , although none of the deaths was deemed related to HD treatment . No deaths occurred in the daily HD group . Vascular access differences between study groups were not statistically significant . Among patients with arteriovenous ( AV ) fistulae , more than 80 % of  daily HD and nocturnal HD patients elected to use the buttonhole technique and successfully performed quotidian HD through their buttonhole at the 18-month follow-up . Patients with AV fistulae had the lowest annual rates of access complications and interventions . The annual access infection rate for quotidian HD patients using catheters decreased significantly after patients switched from in-center conventional HD to more frequent HD treatments at home . CONCLUSION Results from this comprehensive and pioneering study support the hypothesis that quotidian HD is more physiological than conventional HD and results in better patient outcomes Fluid and solute fluctuations during the week are the main drawbacks of conventional hemodialysis ( cHD ) in patients ’ outcomes . The aim of our study was to evaluate the influence of every other day hemodialysis ( eodHD ) on clinical and laboratory parameters and to compare to that of cHD . Eighteen patients on cHD were included in the study . Nine patients ( group I ) were r and omly switched to eodHD , while the rest ( group II ) remained on their regular cHD . By the end of the study ( 12 months ) we observed a reduction in body weight followed by a parallel reduction in predialysis mean blood pressure by 7 mm Hg in group I ( p < 0.05 ) and the number of antihypertensives . Moreover , a reduction in left ventricular mass and an increment of ejection fraction was observed in group I. Hemoglobin levels remained stable in both groups , but erythropoietin dose was reduced in eodHD group . Dialysis delivered dose ( dpKt/V ) was higher and urea rebound phenomenon was less in group I. Finally , an improvement in uremia related and postdialysis symptoms was observed in the same group of patients . Our results showed that  eodHD  improved patients ’ clinical and biochemical status and therefore might have advantages in patients ’ outcomes compared with cHD BACKGROUND Causes of hypertension and cardiac hypertrophy in  hemodialysis ( HD ) patients are multiple , but the role of fluid overload appears to be crucial . Short daily HD ( sDHD = 2 hr x 6/week ) seems to allow reductions in left ventricular mass ( LVM ) through the reduction of extracellular water ( ECW ) . Better cardiovascular stability during HD can be obtained with short , but more frequent HD sessions , but also by increasing the session length accompanied with a reduction in ultrafiltration (UF)/hr . Regardless of the method , the adequate reduction in extracellular volume should permit better control of hypertension and left ventricular hypertrophy ( LVH ) . This study aim ed to compare sDHD with an extended form of st and ard HD ( eSHD = 4.5 - 5 hr x 3/week ) on the reduction of fluid overload , blood pressure ( BP ) and LVM index ( LVMi ) . PATIENTS AND METHODS Twenty-four HD patients with hypertension and LVH were enrolled in a prospect i ve non-r and omized study . After a 3-month run-in period they were divided in two comparable groups : 12 patients treated with sDHD , and 12 patients treated with eSHD for 6 months . LVMi , 24 hr BP monitoring , ECW , determined with electrical bio-impedance , biochemical correlates and spKT/V were studied at the beginning of the study and 6 months later . RESULTS The weekly session length was increased in eSHD from 722.9 + /- 7.5 to 877.3 + /- 35.5 min . ECW% was reduced similarly in the two groups ( Delta ECW : eSHD = 4.6 + /- 2.4 L ; sDHD = 4.1 + /- 2.3 L ) ; 24 hr BP decreased significantly from 157/81 to 137/75 mmHg in eSHD , and from 149/79 to 128/72 mmHg in sDHD . The reduction in systolic BP was similar in the two groups ( eSHD = 20.1 + /- 15.3 mmHg , sDHD = 21. 
    Output:
    
Moderate- quality evidence indicated that earlier dialysis therapy initiation ( at estimated creatinine clearance [ eClcr ] of 10 - 14mL/min ) did not reduce mortality compared to later initiation ( eClcr of 5 - 7mL/min ) .
More than thrice-weekly hemodialysis and extended-length hemodialysis during a short follow-up did not improve clinical outcomes compared to conventional hemodialysis and result ed in a greater number of vascular access procedures ( very low- quality evidence ) .
Hemodialysis using high-flux membranes did not reduce all-cause mortality , but reduced cardiovascular mortality compared to hemodialysis using low-flux membranes ( moderate- quality evidence ) .
Limited data indicate that earlier dialysis therapy initiation and more frequent and longer hemodialysis did not improve clinical outcomes compared to conventional hemodialysis