Interventions Made to Preserve Cognitive Function

Hemodialysis-based Interventions to Preserve Cognitive Function

This is a randomized, controlled trial to slow cognitive decline in adults undergoing hemodialysis (HD). The investigators will test three interventions cognitive training (CT), exercise training (ET), and combined cognitive and exercise training (CT+ET) relative to standard of care (SC).

This will be a two by two factorial, randomized, controlled trial to slow cognitive decline in adults undergoing hemodialysis (HD). The investigators primary objective is to determine if receiving cognitive training (tablet-based brain games), exercise training (stationary foot pedal), or combined cognitive and exercise training preserves executive function relative to those with standard of care . The secondary objectives are to compare the rates of end stage renal disease (ESRD)-specific clinical outcomes and patient centered outcomes among those receiving CT, or ET, or CT+ET relative to those in SC. The investigators will formally test whether receiving CT or ET will preserve executive function and receiving combined CT+ET will preserve executive function better than CT or ET alone.

Inclusion Criteria:

• 18 years or older at enrollment
• English speaking
• within 3 months to 3 years of initiating hemodialysis
• receiving hemodialysis at participating dialysis centers

Exclusion Criteria: Patients with the following conditions will be excluded:

• Pregnancy
• Angina Pectoris
• Chronic lung disease requiring oxygen
• Musculoskeletal conditions that limit mobility
• Upper or lower extremity amputation
• Orthopedic disorders exacerbated by physical activity
• Femoral arteriovenous (AV) access
• Hepatitis B infection
• Blindness/Legal blindness

In addition to conditions outlined above, patients who are currently incarcerated will be excluded from the study.