You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
No Difference in Average Interdialytic Weight Gain Observed in a Randomized Trial With a Technology-Supported Behavioral Intervention to Reduce Dietary Sodium Intake in Adults Undergoing Maintenance Hemodialysis in the United States: Primary Outcomes of the BalanceWise Study.
Abstract 1:
OBJECTIVE To evaluate the efficacy of behavioral counseling combined with technology-based self-monitoring for sodium restriction in hemodialysis ( HD ) patients . DESIGN R and omized clinical trial . SUBJECTS English literate adults undergoing outpatient , in-center intermittent HD for at least 3 months . INTERVENTIONS Over a 16-week period , both the intervention and the attention control groups were shown 6 educational modules on the HD diet . The intervention group also received social cognitive theory-based behavioral counseling and monitored their diets daily using h and held computers . MAIN OUTCOME MEASURES Average daily interdialytic weight gain ( IDWGA ) was calculated for every week of HD treatment over the observation period by subtracting the post-dialysis weight at the previous treatment time ( t-1 ) from the pre-dialysis weight at the current treatment time ( t ) , dividing by the number of days between treatments . Three 24-hour dietary recalls were obtained at baseline , 8 weeks , and 16 weeks and evaluated using the Nutrient Data System for Research . RESULTS A total of 179 participants were r and omized , and 160 ( 89.4 % ) completed final measurements .  IDWGA did not differ significantly by treatment group at any time point considered ( P > .79 for each ) . A significant differential change in dietary sodium intake observed at 8 weeks ( -372 mg/day ; P = .05 ) was not sustained at 16 weeks ( -191 mg/day ; P = .32 ) . CONCLUSION The BalanceWise Study intervention appeared to be feasible and acceptable to HD patients although IDWGA was unchanged and the desired behavioral changes observed at 8 weeks were not sustained . Unmeasured factors may have contributed to the mixed findings , and further research is needed to identify the appropriate patients for such interventions


Title 2:
Association Between Home Blood Pressure and Body Composition by Bioimpedance Monitoring in Patients Undergoing Peritoneal Dialysis.
Abstract 2:
Home blood pressure ( HBP ) is an independent predictor of cardiovascular and renal function . However , no particular guidelines have been established for optimal HBP in peritoneal dialysis ( PD ) patients .  Bioelectrical impedance analysis ( BIA ) is a beneficial tool for determining body composition . In the present study , we used BIA to determine body composition parameters that might play a role in the regulation of HBP in PD patients , and we compared HBP with office blood pressure ( BP ) . Our study enrolled 15 patients ( 11 men , 4 women ) receiving PD at Tohoku University Hospital , who , for 1 year , agreed to monitor HBP and to undergo body composition analysis . Patients were requested to measure HBP twice daily ( morning , night ) using a home BP device . A bioimpedance monitor was used to monitor body composition each month . Blood and urine sample s were also analyzed each month . The relationships of average morning systolic HBP ( sMHBP ) with parameters of body composition and of blood and urine analyses were evaluated . The enrolled patients were 66.3 ± 7.7 years of age and had a PD vintage of 28.3 ± 6.4 months . Overall , their sMHBP was 128 ± 13 mmHg and their office systolic BP was 126 ± 15 mmHg . Although office systolic BP and sMHBP both correlated with body fluid parameters [ total body water (TBW)/height2 ] , renal function ( renal Kt/V serum creatinine ) , and heart function ( left ventricular mass index ) , the correlation coefficient for sMHBP and TBW/height2 was highest , with sMHBP being the only independent predictor . Sodium intake was associated only with sMHBP . Our results suggest that body fluid status determined by BIA , heart and renal function , and sodium intake show better associations with sMHBP than with office systolic BP . Monitoring HBP and body composition by BIA are beneficial for the maintenance of volume status in PD patients


Title 3:
Treatment of Muscle Cramps during Maintenance Haemodialysis
Abstract 3:
The effect of a slowly released oral preparation of sodium chloride ( Slow Sodium ) on the frequency and severity of muscle cramps , on blood pressure , and on body weight was compared with that of placebo in a double-blind cross-over trial in 19 patients on maintenance haemodialysis for end-stage renal failure . A significant reduction in both the frequency and severity of cramps was found while the patients were receiving the sodium chloride preparation and no significant alteration in blood pressure or body weight was detected


Title 4:
Impact of hypertension on cardiomyopathy, morbidity and mortality in end-stage renal disease.
Abstract 4:
A cohort of 432 ESRD ( 261 hemodialysis and 171 peritoneal dialysis ) patients was followed prospect ively for an average of 41 months . Baseline and annual demographic , clinical and echocardiographic assessment s were performed , as well as serial clinical and laboratory tests measured monthly while on dialysis therapy . The average mean arterial blood pressure level during dialysis therapy was 101 + /- 11 mm Hg . After adjusting for age , diabetes and ischemic heart disease , as well as hemoglobin and serum albumin levels measured serially , each 10 mm Hg rise in mean arterial blood pressure was independently associated with : the presence of concentric LV hypertrophy ( OR 1.48 , P = 0.02 ) , the change in LV mass index ( beta = 5.4 g/m2 , P = 0.027 ) and cavity volume ( beta = 4.3 ml/m2 , P = 0.048 ) on follow-up echocardiography , the development of de novo cardiac failure ( RR 1.44 , P = 0.007 ) , and the development of de novo ischemic heart disease ( RR 1.39 , P = 0.05 ) . The association with LV dilation was of borderline statistical significance ( OR 1.48 , P = 0.06 ) . Mean arterial blood pressures greater than 106 mm Hg were associated with both echocardiographic and clinical endpoints . Paradoxically , low mean arterial blood pressure ( RR 1.36 per 10 mm Hg fall , P = 0.009 ) was independently associated with mortality . The association of low blood pressure with mortality was a marker for having had cardiac failure prior to death . We conclude that even moderate hypertension worsens the echocardiographic and clinical outcome in ESRD patients , especially in those without previous clinical cardiac disease


Title 5:
Effect of dietary sodium restriction on body water, blood pressure, and inflammation in hemodialysis patients: a prospective randomized controlled study
Abstract 5:
Purpose Accumulating evidence suggests an association between body volume overload and inflammation in chronic kidney diseases . The purpose of this study was to evaluate the effect of dietary sodium reduction in body fluid volume , blood pressure ( BP ) , and inflammatory state in hemodialysis ( HD ) patients . Methods In this prospect i ve controlled study , adult patients on HD for at least 90 days and those with C-reactive protein ( CRP ) levels ≥0.7 mg/dl were r and omly allocated into two groups : group  A , which included 21 patients treated with 2 g of sodium restriction on their habitual diet ;  and  group B , which included 18 controls .  Clinical , inflammatory , biochemical , hematological , and nutritional markers were assessed at baseline and after 8 and 16 weeks . Results Baseline characteristics were not significantly different between the groups . Group A showed a significant reduction in serum concentrations of CRP , tumor necrosis factor-α , and interleukin-6 during the study period , while BP and extracellular water ( ECW ) did not change . In group B , there were no changes in serum concentrations of inflammatory markers , BP , and ECW . Conclusions Dietary sodium restriction is associated with the attenuation of the inflammatory state , without changes in BP and ECW , suggesting inhibition of a salt-induced inflammatory response


Title 6:
Commonly prescribed salt intake in continuous ambulatory peritoneal dialysis patients is too restrictive: results of a double-blind crossover study.
Abstract 6:
Salt restriction in continuous ambulatory peritoneal dialysis ( CAPD ) patients is widely prescribed and thereby may reduce quality of life . It is presumed that this has a beneficial effect on BP and reduces the need for hypertonic dialysate . However , this has never been formally evaluated . A double-blind crossover study of placebo versus sodium chloride pills ( 60 mEq of sodium per day ) is presented in 20 stable CAPD patients , 10 of whom were hypertensive .  Dietary sodium was quantified throughout the study by 3-d dietary histories and remained unaltered throughout . There was a clinical ly unimportant but statistically significant rise in BP with added salt : 135/77 to 144/82 ( P < 0.05 ) . No rise in BP occurred in the hypertensive patients .  Weights , use of hypertonic dialysate , and BP medications remained unaltered throughout the study . In conclusion , 200 mEq of sodium per day , i.e. , a normal sodium intake , is easily tolerated in stable CAPD patients , and the recommended sodium intake commonly prescribed is too restrictive


Title 7:
Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients.
Abstract 7:
Dietary sodium is thought to play a major role in the pathogenesis of hypertension , hypervolemia , and mortality in hemodialysis patients ; hence , sodium restriction is almost universally recommended . Since the evidence upon which to base these assumptions is limited , we undertook a post-hoc analysis of 1770 patients in the Hemodialysis Study with available dietary , clinical , and laboratory information . Within this cohort , 772 were men , 1113 black , and 786 diabetic , with a mean age of 58 years and a median dietary sodium intake of 2080 mg/day . After case-mix adjustment , linear regression modeling found that higher dietary sodium was associated with a greater ultrafiltration requirement , caloric and protein intake ; sodium to calorie intake ratio was associated with a greater ultrafiltration requirement ; and sodium to potassium ratio was associated with higher serum sodium . No indices were associated with the pre-dialysis systolic blood pressure . Cox regression modeling found that higher baseline dietary sodium and the ratio of sodium to calorie or potassium were each independently associated with greater all-cause mortality . No association between a prescribed dietary sodium restriction and mortality were found . Thus , higher reported dietary sodium intake is independently associated with greater mortality among prevalent hemodialysis patients . R and omized trials will be necessary to determine whether dietary sodium restriction improves survival
In conclusion , few studies have investigated the role of dietary salt reduction in individuals with ESRD receiving dialysis , but these results suggest the importance of this intervention for lowering blood pressure in this group