title: Effect of more frequent hemodialysis on cognitive function in the frequent hemodialysis network trials.
abstract: BACKGROUND
  Cognitive impairment is common in patients with end-stage renal disease receiving hemodialysis 3 times per week.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  218 individuals participating in the Frequent Hemodialysis Network (FHN) Daily Trial and 81 participating in the FHN Nocturnal Trial.
  
  
  METHODS
  The Daily Trial tested in-center hemodialysis 6 times per week versus 3 times per week. The Nocturnal Trial tested home nocturnal hemodialysis 6 times per week versus home or in-center hemodialysis 3 times per week.
  
  
  RESULTS
  Cognitive function was measured at baseline, month 4, and month 12. The primary outcome was performance on the Trail-Making Test, Form B, a measure of executive function, and a secondary outcome was performance on the Modified Mini-Mental State Examination, a measure of global cognition. The domains of attention, psychomotor speed, memory, and verbal fluency were assessed in 59 participants in the Daily Trial and 19 participants in the Nocturnal Trial.
  
  
  RESULTS
  We found no benefit of frequent hemodialysis in either trial for the primary cognitive outcome (Daily Trial: OR for improvement, 0.99; 95% CI, 0.59-1.66; Nocturnal Trial: OR, 1.19; 95% CI, 0.48-2.96). Similarly, there was no benefit of frequent hemodialysis in either trial on global cognition, the secondary cognitive outcome. Exploratory analyses in the Daily Trial suggested possible benefits of frequent hemodialysis for memory and verbal fluency, but not for attention and psychomotor speed. Exploratory analyses in the Nocturnal Trial suggested no benefit of frequent hemodialysis on attention, psychomotor speed, memory, or verbal fluency.
  
  
  CONCLUSIONS
  Unblinded intervention, small sample.
  
  
  CONCLUSIONS
  Frequent hemodialysis did not improve executive function or global cognition.
authors.affiliation: Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94304, USA. mktamura@stanford.edu
authors.forename: Manjula
authors.initials: M
authors.lastname: Kurella Tamura
authors.forename: Mark L
authors.initials: ML
authors.lastname: Unruh
authors.forename: Allen R
authors.initials: AR
authors.lastname: Nissenson
authors.forename: Brett
authors.initials: B
authors.lastname: Larive
authors.forename: Paul W
authors.initials: PW
authors.lastname: Eggers
authors.forename: Jennifer
authors.initials: J
authors.lastname: Gassman
authors.forename: Ravindra L
authors.initials: RL
authors.lastname: Mehta
authors.forename: Alan S
authors.initials: AS
authors.lastname: Kliger
authors.forename: John B
authors.initials: JB
authors.lastname: Stokes
mesh_terms: D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods*; D013997:Time Factors