Evaluation of the effect of Cooled HaEmodialysis on Cognitive function in patients suffering with end-stage KidnEy Disease (E-CHECKED): feasibility randomised control trial protocol

Research output: Contribution to journalArticlepeer-review


  • Indranil Dasgupta
  • Aghogho Odudu
  • Jyoti Baharani
  • Niall Fergusson
  • Helen Griffiths
  • John Harrison
  • Paul Maruff
  • Gavin Woodhall
  • Samir Youseff
  • George Tadros

External organisations

  • Heartlands Hospital
  • Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
  • The Surrey Business School , University of Surrey , Guildford , UK
  • King's Health Partners Cancer Biobank, King's College London, London, UK.
  • Cogstate Limited
  • Institute for Applied Health Research
  • f Patient representative.


BACKGROUND: Cognitive impairment is common in haemodialysis (HD) patients and is associated independently with depression and mortality. This association is poorly understood, and no intervention is proven to slow cognitive decline. 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 study addresses whether cooler dialysate can prevent the decline in cognition and improve quality of life (QOL) in HD patients.

METHODS: This is a multi-site prospective randomised, double-blinded feasibility trial.

SETTING: Four HD units in the UK.

PARTICIPANTS AND INTERVENTIONS: Ninety HD patients randomised (1:1) to standard care (dialysate temperature 36.5 °C) or intervention (dialysate temperature 35 °C) for 12 months.

PRIMARY OUTCOME MEASURE: Change in cognition using the Montreal Cognitive Assessment (MoCA).

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.

ANALYSIS: mixed method approach, utilising measurement of cognition, questionnaires, physiological measurements and semi-structured interviews.

DISCUSSION: 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. 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 °C, versus a standard dialysis fluid temperature of 36.5 °C. This also should reflect in improvements in their abilities for activities of daily living and therefore reduce carers' burden. If successful, the treatment could be universally applied at no extra cost.

TRIAL REGISTRATION: ClinicalTrials.gov NCT03645733 . Registered retrospectively on 24 August 2018.


Original languageEnglish
Pages (from-to)820
Issue number1
Publication statusPublished - 30 Sep 2020