***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 their broad spectrum , cardiovascular diseases are , collectively , the major cause of death in patients on dialysis .  The population of patients treated with peritoneal dialysis and hemodialysis  are not only subject to the traditional risk factors for heart disease , but also to certain uremia-associated risk factors that are unique in this population . In the dialysis population , data regarding the effectiveness of routine pharmacologic and procedural interventions on cardiovascular outcomes are limited . Most dialysis patients are excluded from clinical trials , and so data from r and omized controlled trials investigating outcomes in patients undergoing  peritoneal dialysis or hemodialysis are almost absent . In this review , we discuss some of the major cardiovascular problems in the dialysis population , the impact of those problems on survival , and when data are available , the impact of therapeutic strategies BACKGROUND Malnutrition is a common problem in hemodialysis ( HD ) patients and one of the most important factors influencing morbidity and mortality . More frequent HD has been shown to improve nutritional status in HD patients . METHODS The London Daily/Nocturnal Hemodialysis Study compared the nutritional status of patients receiving quotidian HD , either short daily HD ( n = 11 ) or long nocturnal HD ( n = 12 ) , with that of 22 matched control patients receiving conventional thrice-weekly HD .  A number of biochemical parameters indicative of nutritional status were measured , including protein equivalent of total nitrogen appearance ( nPNA ) , serum albumin , serum prealbumin , dietary calcium , serum lipids , and water-soluble vitamin levels . RESULTS nPNA tended to increase throughout the study for both quotidian HD groups and remained unchanged in the control group , which had the lowest values ( 1 to 1.1 g/kg/d ) . Daily HD patients showed a significant increase in mean serum albumin levels at 3 , 12 , and 18 months . The nocturnal HD group showed a significant decrease in albumin levels at month 9 , and control patients maintained relatively stable albumin levels throughout the study . Serum prealbumin levels averaged 0.04 g/dL for daily HD patients , whereas serum prealbumin levels decreased in nocturnal HD patients during the study period . Half the nocturnal HD patients had vitamin C levels lower than the reference range . Body composition data showed increased arm muscle area and maintenance of 100 % to 110 % of relative body weight ( RBW ) after several months of daily HD , whereas patients on nocturnal HD therapy showed a significant decline in RBW . There were no significant differences in lean body mass , percentage of body fat , or body mass index among the 3 study groups . CONCLUSION Increased nPNA , serum albumin levels , and arm muscle area suggest that daily HD patients experienced improved nutritional status Despite the continuous improvement of dialysis technology and pharmacological treatment , mortality rates for dialysis patients are still high . A 2-year prospect i ve study was conducted at a tertiary care hospital to determine the factors influencing survival among patients on maintenance hemodialysis . 96 patients with end-stage renal disease surviving more than 3 months on hemodialysis ( 8 - 12 h/week ) were studied . Follow-up was censored at the time of death or at the end of 2-year study period , whichever occurred first . Of the 96 patients studied ( mean age 49.74 ± 14.55 years , 75 % male and 44.7 % diabetics ) , 19 died with an estimated mortality rate of 19.8 % . On an age-adjusted multivariate analysis , female gender and hypokalemia independently predicted mortality . In Cox analyses , patient survival was associated with delivered dialysis dose ( single pool Kt/V , hazard ratio [ HR ] = 0.01 , P = 0.016 ) , frequency of hemodialysis ( HR = 3.81 , P = 0.05 ) and serum albumin ( HR = 0.24 , P = 0.005 ) . There was no significant difference between diabetes and non-diabetes in relation to death ( Relative Risk = 1.109 ; 95 % CI = 0.49 - 2.48 , P = 0.803 ) . This study revealed that mortality  among hemodialysis patients remained high , mostly due to sepsis and ischemic heart disease . Patient survival was better with higher dialysis dose , increased frequency of dialysis and adequate serum albumin level . Efforts at minimizing infectious complications , preventing cardiovascular events and improving nutrition should increase survival among hemodialysis patients 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 Hypertension and interdialytic weight gain are associated with left ventricular hypertrophy ( LVH ) , an important predictor of cardiovascular mortality in hemodialysis ( HD ) patients . METHODS In the London Daily/Nocturnal Hemodialysis Study , a group of patients receiving quotidian HD , either short daily ( n = 11 ) or long nocturnal ( n = 12 ) , were followed for up to 18 months . Patients were assessed for effects of quotidian HD therapy on blood pressure , interdialytic weight gain , extracellular fluid volume ( ECFV ) , intensity of antihypertensive therapy , and homocysteine levels . RESULTS Significant reductions in predialysis mean arterial blood pressure were observed in the daily HD group at 6 months ( P < 0.04 ) and in the nocturnal HD group at 9 months ( P < 0.03 ) ; these improvements persisted throughout the study period . The daily HD group had a 60 % reduction in mean number of antihypertensive tablets per day at 1 month and an 8.8-fold reduction by 18 months . Nocturnal HD patients experienced a 3.3-fold reduction , and control patients , a 1.4-fold increase in mean number of tablets per day by 18 months . By 3 months , the daily HD group showed a significant decrease in interdialytic weight gain ( P < 0.0005 ) and lower ECFV than controls ( P < 0.05 ) . The nocturnal HD group had a transient , but significant , increase in interdialytic weight gain at 6 and 15 months ( P < 0.05 ) and no difference in ECFV compared with controls , suggesting a different mechanism of blood pressure control . Homocysteine levels were significantly lower for both quotidian HD groups compared with conventional HD patients . CONCLUSION Quotidian HD is a promising therapy with potent antihypertensive effects , result ing in improved blood pressure control . This , together with improved homocysteine levels , may be beneficial in the long term with regard to cardiovascular mortality Since 1972 all persons with end stage renal disease ( ESRD ) eligible for Social Security are entitled to all Medicare benefits , regardless of age . ESRD patients need continual renal replacement therapy to survive . Although only 1 percent of Medicare beneficiaries suffer from ESRD , they account for roughly 9 percent of all Medicare payments . ESRD patients tend to be economically disadvantaged and belong to ethnic and racial minorities . CMS has developed many programs and regulations specifically for ESRD patients design ed to improve care , pay providers fairly , and minimize government expenditures . Currently , most ESRD patients are covered through a mix of mechanisms within the traditional fee-for-service ( FFS ) payment system , including : The composite rate covers services generally part of a single in-center hemodialysis treatment . The monthly capitation payment , which reimburses the physician , such as a nephrologist , who prescribes and monitors the patient 's dialysis . The payment amount for erythropoietin ( EPO ) to treat anemia is set by Congress at an allowed charge of $ 10 per thous and units . The first two methods act as prospect i ve payment systems ( PPSs ) for the services covered by the payments . Hospitalizations for ESRD patients are paid through the same PPS as all Medicare patients . Dialysis , hospitalizations , and physicians ' dialysis services comprise over 80 percent of Medicare expenditures for the care of dialysis patients . The traditional FFS system for dialysis patients is , in effect , a system of partial capitation . Medicare is the primary insurer for dialysis patients . Providers , patients , and nonprofit organizations take an active interest in any changes or potential changes to CMS payment or coverage policies . Other insurers and State Medicaid Programs often base their own procedures on those developed by CMS . Research into the efficient care of dialysis and transplant patients is of great interest to Medicare policymakers . Therefore , many people in and out of the government follow and contribute to research issues related to ESRD policy . This issue of the Review contains seven articles reporting findings from policy-relevant research . The first four articles derive from the independent evaluation of the ESRD managed care demonstration conducted by a team from The Lewin Group and the University Renal Research and Education Association . These articles are a subset of the topics covered in the joint final evaluation report ( The Lewin Group and the University Renal Research and Education Association , 2002 ) and the Secretary 's Report to Congress ( Centers for Medicare & Medicaid Services , 2002 ) . Next , the Kidney Epidemiology and Cost Center at the University of Michigan presents initial results suggesting that data of adequate quality exist to develop a risk-adjustment system for an exp and ed composite rate bundle . The last two articles deal with long-term issues important to ESRD patients :  improving the quality of care for dialysis patients  and increasing the number of kidneys donated and recovered for transplantation 
    Output:
    
A greater reduction of volume ( salt and water ) with higher frequency can improve patient quality of life ( QOL ) .
Overall , the studies showed that EHD result ed in improved blood pressure management ; therefore , we concluded that there will be a decrease in cardiovascular disease risk , stroke , and morbidity and mortality rate .
There will be also an improvement in patient QOL due to beneficial effects of the EHD