Cognitive impairment is a well-recognized complication of ESRD and only 13% of hemodialysis patients have normal cognitive function. Cognitive decline often starts early in the progression of kidney disease and continues to decline while undergoing HD at a rate much faster than the general population. This is associated with multiple adverse consequences including difficulty of care, depression, dialysis withdrawal, increased hospitalizations, low quality of life and increased mortality.There are many potential causes, including uraemic toxins (neurotoxins), common underlying factors responsible for progression of both renal impairment and cognitive dysfunction (as diabetes mellitus, hypertension, increased oxidative stress and persistent chronic inflammation), as well as increased prevalence of silent cerebral infarction, cerebral atrophy and cerebral microbleeds.
Executive function is the domain of cognition that is most affected by HD initiation. In an attempt to reduce cognitive decline in patients on HD, There is research on non-pharmacological approaches to minimize cognitive impairment or improve daily functioning as cognitive rehabilitation and recently intradialytic cognitive training by playing some video games was assessed and found to improve certain cognitive tasks that may even extend to involve other untrained tasks.