Comparison of Dialysis Therapies on Cognitive Function

• Longitudinal analysis of cognitive function over time to test the hypothesis that more frequent hemodialysis contributes to delay in cognitive function impairment [ Time Frame: baseline, 4 months and 12 months ] [ Designated as safety issue: No ]
• To test the hypothesis that nightly or daily hemodialysis treatment can ultimately be proven to be cost effective options by preserving cognitive function. [ Time Frame: 12 months ] [ Designated as safety issue: No ]
• Influence of cognitive function on survival. [ Time Frame: 12 months ] [ Designated as safety issue: No ]

This study will evaluate the effects of more frequent dialysis on cognitive function including the assessment of sleep apnea and restless legs. Our hypothesis is that more frequent dialysis improves cognitive function and may have important implications on clinical care of ESRD patients and help to emphasize the need for treatments that will allow patients to live "with dialysis" rather than live "for dialysis".

Subjects with Chronic Kidney Disease (CKD) who require renal replacement therapy and who are currently receiving dialysis.

• End Stage Renal Disease
• Chronic Kidney Disease

• Other: Cognitive Function Testing-10 Tests
  Trailmaking A, Trailmaking B, Rey Auditory Verbal Learning, Letter Number Sequencing, Digit Symbol Substitution, Grooved Pegboard, Controlled Oral Word Association, Beck Depression Index, Feeling Thermometer, Modified Mini-Mental Status
• Other: Sleep Assessment Testing
  Sleep Assessment will be performed using an "Actiwatch" with subjects wearing the watch for 72 hours continuously
• Other: Periodic Leg Movement Syndrome Assessment
  Subjects will wear and "Actiwatch" on both legs for three consecutive nights.

• 1
  Prevalent patients who have been receiving more frequent dialysis.
  Interventions:

  • Other: Cognitive Function Testing-10 Tests
  • Other: Sleep Assessment Testing
  • Other: Periodic Leg Movement Syndrome Assessment
• 2
  Incident patients new to more frequent dialysis
  Interventions:

  • Other: Cognitive Function Testing-10 Tests
  • Other: Sleep Assessment Testing
  • Other: Periodic Leg Movement Syndrome Assessment
• 3
  Patients who switch from one more frequent hemodialysis treatment regimen to another more frequent dialysis regimen.
  Interventions:

  • Other: Cognitive Function Testing-10 Tests
  • Other: Sleep Assessment Testing
  • Other: Periodic Leg Movement Syndrome Assessment

Inclusion Criteria:

• Diagnosis of ESRD
• Age 18 years or greater
• Ability to understand and a willingness to sign an informed consent statement and a Health Insurance Portability and Accountability Act of 1996 (HIPPA) authorization statement.
• Expected survival of at least one year.

Exclusion Criteria:

• Documented non-compliance, defined as missing more than 10% of prescribed treatments during the month prior to the start of the study.