Multiple HD specific factors including oxidative stress, malnutrition and inflammation are implicated. Traditional atherosclerotic risk factors cannot entirely account for the excess risk of cognitive impairment. Severe depression can even mimic cognitive impairment making it important to measure depression rates in studies of cognitive impairment to understand the interaction. Cognitive impairment in HD patients is associated independently with higher rates of depression and mortality, although this association is likely complex and poorly understood. Different diagnostic methods influence the definition and incidence of cognitive impairment, but recent reviews suggest the presence of at least moderate cognitive impairment in 30–70% of haemodialysis (HD) patients. Increasing severity of chronic kidney disease (CKD) is associated with a gradual increase in prevalence of cognitive impairment independent of vascular risk factors.
Registered retrospectively on 24 August 2018. If successful, the treatment could be universally applied at no extra cost. This also should reflect in improvements in their abilities for activities of daily living and therefore reduce carers’ burden.
Software tanaka future hd trial#
The main hypothesis that would be tested in this future trial is that patients treated with regular conventional haemodialysis will have a lesser decline in cognitive function and a better quality of life over 1 year by using cooler dialysis fluid at 35 ☌, versus a standard dialysis fluid temperature of 36.5 ☌. The results of this feasibility trial will inform the design of a future adequately powered substantive trial investigating the effect of dialysate cooling on prevention and/or slowing in cognitive decline in patients undergoing haemodialysis using a computerised battery of neuro-cognitive tests. Analysis: mixed method approach, utilising measurement of cognition, questionnaires, physiological measurements and semi-structured interviews.
Secondary outcome measures: Recruitment and attrition rates, reasons for non-recruitment, frequency of intradialytic hypotension, depressive symptom scores, patient and carers burden, a detailed computerised cognitive test and QOL assessments. Primary outcome measure: Change in cognition using the Montreal Cognitive Assessment (MoCA).
Participants and interventions: Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5 ☌) or intervention (dialysate temperature 35 ☌) for 12 months. This is a multi-site prospective randomised, double-blinded feasibility trial. This study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients. There is evidence that cooler dialysis fluid (dialysate) may slow white matter changes in the brain, but no study has investigated the effect of cooler dialysate on cognition. This association is poorly understood, and no intervention is proven to slow cognitive decline.
Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality.
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