# Hemodialysis-based interventions to preserve cognitive function

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $715,941

## Abstract

ABSTRACT
Over 640,000 US adults suffer from ESRD, >95% of whom receive hemodialysis (HD) for the rest of their life or
until transplantation. Kidney disease and HD significantly impact cognitive function, especially higher-order
executive function. Only 13% of HD patients have normal cognition; HD patients experience executive function
impairment at a rate 3-fold higher than the general population, leading to hospitalization, disability, and death.
Studies of older adults suggest that the only effective interventions for preserving executive function are
cognitive training (CT) and/or exercise training (ET). These modalities have not been tested for executive
function preservation in HD patients; even younger HD patients suffer substantial executive function
impairment and could benefit from these interventions. HD frequency (3 sessions a week) and duration (4-6
hours/session) makes HD patients a “captive audience” for intradialytic CT and/or ET to mitigate executive
function decline. In preliminary studies, HD patients reported spending most of their time watching TV;
intradialytic CT and/or ET could replace these passive activities. In preliminary studies, 87% of nephrology
providers believed that their patients would be interested in intradialytic CT and 83% believed that their
patients would be interested in intradialytic ET. Among HD patients, 67% wanted to improve their cognition
through CT and 71% wanted to improve their strength and cognition through ET while undergoing HD.
To test the feasibility of intradialytic interventions, we conducted a pilot RCT of 20 HD patients, comparing
standard of care to CT or ET; even in this pilot, we found that intradialytic CT and ET preserved executive
function. As expected, executive function in patients receiving standard of care declined substantially by 3
months (difference=47.4 seconds, P=0.006); however, this decline was not seen among those receiving CT or
ET. Compared with standard of care, the difference in mean change was -46.72 seconds (95% CI: -91.12, -
2.31; P=0.04) for CT and -56.21 seconds (95% CI: -105.86, -6.56; P=0.03) for ET. In just 3 months, CT and ET
preserved executive function compared to a striking decline with standard of care.
To properly test the impact of intradialytic CT and/or ET, on the executive function decline associated with HD,
we propose the following aims: 1) To conduct an RCT to evaluate executive function decline in the setting of
intradialytic CT and/or ET, 2) To quantify the effects of intradialytic CT and/or ET on ESRD-specific clinical
outcomes, 3) To quantify the effects of intradialytic CT and/or ET, on patient-centered outcomes.
Through this RCT, we will learn the impact of two potential non-pharmacological interventions, cognitive and
exercise training, in preserving executive function during HD. If successful, this will improve HD outcomes of
>640,000 adults with ESRD. For the first time, we will have validated, beneficial activities replace the typical
...

## Key facts

- **NIH application ID:** 9844470
- **Project number:** 5R01DK114074-03
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Mara A. McAdams DeMarco
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $715,941
- **Award type:** 5
- **Project period:** 2018-01-09 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9844470

## Citation

> US National Institutes of Health, RePORTER application 9844470, Hemodialysis-based interventions to preserve cognitive function (5R01DK114074-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9844470. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*