***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 
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    Input: There is increasing evidence that the biochemical and cellular phenomena induced by blood/ membrane/dialysate interactions contribute to dialysis-related intradialytic and long-term complications . However , there is a lack of large , prospect i ve , r and omized trials comparing biocompatible and bioincompatible membranes , and convective and diffusive treatment modalities . The primary aim of this prospect i ve , r and omized trial was to evaluate whether the use of polysulfone membrane with bicarbonate dialysate offers any advantage ( in terms of treatment tolerance , nutritional parameters and pre-treatment beta-microglobulin levels ) over a traditional membrane ( Cuprophan ) . A secondary aim was to assess whether the use of more sophisticated methods consisting of a biocompatible synthetic membrane with different hydraulic permeability at different ultrafiltration rate ( high-flux hemodialysis and hemodiafiltration ) offers any further advantages . Seventy-one Centers were involved and stratified according to the availability of only the first two or all four of the following techniques : Cuprophan hemodialysis ( Cu-HD ) , low-flux polysulfone hemodialysis ( LfPS-HD ) , high-flux polysulfone high-flux hemodialysis ( HfPS-HD ) , and high-flux polysulfone hemodiafiltration ( HfPS-HDF ) .  The 380 eligible patients were r and omized to one of the two or four treatments ( 132 to Cu-HD , 147 to LfPS-HD , 51 to HfPS-HD and 50 to HfPS-HDF ) . The follow-up was 24 months . No statistical difference was observed in the algebraic sum of the end points between bicarbonate dialysis with Cuprophan or with low-flux polysulfone , or among the four dialysis methods under evaluation . There was a significant decrease in pre-dialysis plasma beta 2-microglobulin levels in high-flux dialysis of 9.04 + /- 10.46 mg/liter ( 23 % ) and in hemodiafiltration of 6.35 + /- 12.28 mg/liter ( 16 % ) , both using high-flux polysulfone membrane in comparison with Cuprophan and low-flux polysulfone membranes ( P = 0.032 ) . The significant decrease in pre-dialysis plasma beta 2-microglobulin levels could have a clinical impact when one considers that beta 2-microglobulin accumulation and amyloidosis are important long-term dialysis-related complications BACKGROUND Accumulation of larger molecular weight uraemic toxins molecules may have a negative effect on the cardiovascular and nutritional state of dialysis patients and influence uraemic symptomatology . Their clearance can be enhanced by the use of haemofiltration ( HF ) . METHODS The effects of low-flux haemodialysis ( HD ) ( ultrapure dialysate ; polyamide membranes ) and pre-dilution on-line HF ( 1:1 blood/substitution ratio ; target filtration volume : 1.2 times body weight ) on cardiovascular and nutritional parameters , interdialytic levels of uraemic toxins and quality of life ( QOL ; Laupacis question naire ) were assessed during 1 year follow-up . Forty patients were r and omized . RESULTS After 1 year , 27 patients were eligible for analysis ( HF : 13 patients ; HD : 14 patients ) . Left ventricular mass index did not change in the HF patients ( 127+/-33 -- > 131+/-36 g/m(2 ) after 12 months ) or in the HD group ( 135+/-34 -- > 138+/-32 g/m(2 ) ) . Also , there were no changes in pulse wave velocity , and 48 h systolic and diastolic blood pressures . Lean body mass , assessed by dual-energy X-ray absorptiometry , increased in the HF group ( 44.8+/-8.9 -- > 46.2+/-9.6 kg ; P<0.05 ) , but not in the HD group ( 49.4+/-9.2 -- > 50.6+/-8.8 kg ) , although differences between groups were not significant . Insulin-like growth factor-1 levels remained stable in the HF patients , but decreased in the HD group ( P<0.05 between groups ) . QOL for physical symptoms improved in the HF group ( 4.2+/-1.2 -- > 5.0+/-1.1 ; P<0.05 within the HF group and P = 0.06 between groups ) , but not in the HD group ( 4.0+/-1.0 -- > 4.4+/-1.4 ) . beta2-microglobulin , complement factor D and homocysteine decreased significantly in the HF but not in the HD group , whereas l-ADMA , leptin and advanced glycation end-products-related fluorescence did not change . CONCLUSIONS No changes in cardiovascular parameters were observed during pre-dilution on-line HF compared with low-flux HD . Treatment with on-line HF result ed in marked changes in the uraemic toxicity profile , an improvement in physical well-being and a small improvement in nutritional state Some of the morbidity associated with  chronic hemodialysis  is thought to result from retention of large molecular weight solutes that are poorly removed by diffusion in conventional hemodialysis . Hemodiafiltration combines convective and diffusive solute removal in a single therapy . The hypothesis that hemodiafiltration provides better solute removal than high-flux hemodialysis was tested in a prospect i ve , r and omized clinical trial . Patients were r and omized to either on-line postdilution hemodiafiltration or high-flux hemodialysis .  The groups did not differ in body size , treatment time , blood flow rate , or net fluid removal . The filtration volume in hemodiafiltration was 21 + /-1 L. Therapy prescriptions were unchanged for a 12-mo study period . Removal of both small ( urea and creatinine ) and large ( ss(2)-microglobulin and complement factor D ) solutes was significantly greater for hemodiafiltration than for high-flux hemodialysis . The increased urea and creatinine removal did not result in lower pretreatment serum concentrations in the hemodiafiltration group . Pretreatment plasma beta(2)-microglobulin concentrations decreased with time ( P < 0.001 ) ; however , the decrease was similar for both therapies ( P = 0.317 ) . Pretreatment plasma complement factor D concentrations also decreased with time ( P<0.001 ) , and the decrease was significantly greater with hemodiafiltration than with high-flux hemodialysis ( P = 0.010 ) . The conclusion is that on-line hemodiafiltration provides superior solute removal to high-flux hemodialysis over a wide molecular weight range . The improved removal may not result in lower pretreatment plasma concentrations , however , possibly because of limitations in mass transfer rates within the body In patients with ESRD , the effects of online hemodiafiltration on all-cause mortality and cardiovascular events are unclear . In this prospect i ve study , we r and omly assigned 714 chronic hemodialysis patients to online postdilution hemodiafiltration  ( n=358 ) or to continue low-flux hemodialysis  ( n=356 ) . The primary outcome measure was all-cause mortality . The main secondary endpoint was a composite of major cardiovascular events , including death from cardiovascular causes , nonfatal myocardial infa rct ion , nonfatal stroke , therapeutic coronary intervention , therapeutic carotid intervention , vascular intervention , or amputation . After a mean 3.0 years of follow-up ( range , 0.4 - 6.6 years ) , we did not detect a significant difference between treatment groups with regard to all-cause mortality ( 121 versus 127 deaths per 1000 person-years in the online hemodiafiltration and low-flux hemodialysis groups , respectively ; hazard ratio , 0.95 ; 95 % confidence interval , 0.75 - 1.20 ) . The incidences of cardiovascular events were 127 and 116 per 1000 person-years , respectively ( hazard ratio , 1.07 ; 95 % confidence interval , 0.83 - 1.39 ) . Receiving high-volume hemodiafiltration during the trial associated with lower all-cause mortality , a finding that persisted after adjusting for potential confounders and dialysis facility . In conclusion , this trial did not detect a beneficial effect of hemodiafiltration on all-cause mortality and cardiovascular events compared with low-flux hemodialysis . On-treatment analysis suggests the possibility of a survival benefit among patients who receive high-volume hemodiafiltration , although this subgroup finding requires confirmation BACKGROUND Morbidity and mortality rates in diabetic patients on regular dialysis treatment ( RDT ) are higher than in non-diabetic-subjects on RDT . Moreover , diabetic patients experience an intradialitic morbidity unacceptably higher than in patients with other causes of terminal renal failure . The aim of the present investigation was to compare st and ard bicarbonate haemodialysis ( BHD ) with acetate-free biofiltration ( AFB ) in a group of 41 diabetic patients stable on dialysis treatment for 25 + /- 22 months . METHODS Twenty-four type II and 17 type I diabetic patients , all requiring insulin therapy , were included and were followed for 1 year in a 6-month cross-over r and omized study for both methods . The analysis was carried out on dialysis symptoms , interdialysis symptoms , and nutritional status , and the multivariate analysis of variance for repeated measures on the same subjects in the two techniques was used . RESULTS AFB significantly reduced dialytic and extradialytic symptoms ( P=0.003 and 0.001 respectively ) . Cardiovascular collapses decreased by 43 % , and other dialysis symptoms showed a similar trend ( -35 % ) . The interdialysis symptoms decreased by 28 % and were accompanied by an increase in subjective wellbeing ( 39 % ) when patients were switched from traditional haemodialysis to AFB .  Acid base control was better with AFB ( P=0.01 ) , both at the beginning and during the session . Slightly significant differences were also obtained for Kt/V ( AFB 1.48 + /- 0.29 vs BHD 1.38 + /- 0.30 ) , while no significant difference was noted with respect to sodium mass balance , nutritional status , calorie-protein intake , nPCR , blood glucose profile , and insulin requirements . The number of hospital admissions and the mortality rate , which were much lower during the AFB than the BHD period , were not analysed statistically . CONCLUSIONS AFB allows better control of some metabolic aspects , reduces intra- and extradialysis symptoms , and improves patient quality of life . Whether the long-term prognosis can be improved by AFB remains to be established with further studies Chronic inflammation contributes to the pathogenesis of several complications of hemodialysis therapy . It is thought that backfiltration of bacteria-derived contaminations during dialysis may induce a chronic inflammatory state . High-sensitivity C-reactive protein ( hs-CRP ) is one of the tools which can take a hold on such a chronic inflammatory condition . We examined the effect of ultrapure dialysate which contributes to chronic inflammation with hs-CRP and tried to reduce endotoxin ( ET ) levels at the end of the dialysate from 70 EU/l to < 1.0 EU/l ( ultrapure dialysate ) . Other dialysis conditions , except ET level , were fixed . We investigated the hs-CRP of 23 patients receiving regular dialysis before the use of ultrapure dialysate and 1 year after use of it prospect ively . The data showed a significant decrease in the median value of the hs-CRP from 0.16 to 0.07 mg/dl ( p < 0.05 ) . The value of serum β2-microglobulin decreased from 33.2 to 28.4 mg/dl ( p < 0.01 ) and the hemoglobin level increased from 10.0 to 11.0 g/dl ( p < 0.05 ) . These results indicate that even a dialysate containing 70 EU/l of ET level may induce a chronic inflammatory state . hs-CRP is a very useful marker of chronic inflammation and the use of ultrapure dialysate is necessary to improve a chronic inflammatory state . The targeted ET level at the end of the dialysate should be set at ≤1.0 EU/l Background : Controlled r and omised studies to prove improved cardiovascular stability and improved anaemia management during on-line haemodiafiltration  ( oHDF ) are scarce . Methods : 70 patients were treated with both haemodialysis ( HD ) and oHDF  in a cross-over design during 2 × 24 weeks at a dialysis dose of eKt/V≧1.2 . Patients r and omised into group A started on HD and switched over to oHDF , whereas patients in group B began with oHDF and were treated with HD  afterwards . Intradialytic morbid events ( IME ) , such as symptomatic hypotension or muscle cramps , were noted in case 
    Output:
    
CONCLUSIONS Treatment effects of convective dialysis are unreliable due to limitations in trial methods and reporting .
Convective dialysis may reduce cardiovascular but not all-cause mortality , and effects on nonfatal cardiovascular events and hospitalization are inconclusive