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The following is a summary of “Evaluation of effect of cooled haemodialysis on cognition in patients with end-stage kidney disease (ECHECKED) feasibility randomised controlled trial results,” published in the December 2024 issue of Nephrology by Dasgupta et al. 

Cognitive impairment is prevalent in patients with hemodialysis. Cooler dialysate may slow brain white-matter changes, but its impact on cognition remains unclear. 

Researchers conducted a feasibility trial to assess the impact of cooled hemodialysis on cognition in patients with end-stage kidney disease (ESKD).  

They randomized 90 patients with hemodialysis (1:1) to standard care (dialysate temperature 36.5 °C) or intervention (35 °C). Eligible participants were adult chronic hemodialysis recipients without dementia or psychiatric disease. The primary outcome was the Montreal Cognitive Assessment (MoCA) score change at 12 months. Secondary outcomes included recruitment and attrition rates, reasons for non-recruitment, intradialytic hypotension, depression, patient burden, computerized cognition test battery, and quality of life (QoL). 

The results showed that of 334 patients screened, 160 were eligible. About 99 declined due to extra non-dialysis day visits; 61 consented, and 43 were randomized (20 standard care, 23 intervention). Then, 13 withdrew before randomization, and 27 completed the trial (12 standard care, 15 intervention). Of these, 5 died, 1 was transplanted, 4 withdrew consent, and 6 could not attend due to the pandemic. Low-temperature dialysis was well tolerated. There was no difference in MoCA change between groups from baseline to 12 months (standard care: 1.0, P = 0.755; intervention: −2.0, P = 0.047). No differences were found in secondary measures or adverse events (AEs). 

Investigators concluded that the trial was significantly impacted by the COVID-19 pandemic, resulting in a 27% attrition rate. Lessons learned will guide the design of future definitive trials in this area. 

Source: bmcnephrol.biomedcentral.com/articles/10.1186/s12882-024-03883-6