Preliminary Efficacy of an Integrated Cognitive and Self-Management Training Program in Hemodialysis Patients

Abstract

Background: Hemodialysis (HD) serves as the primary mode of renal replacement therapy for the majority of these patients, yet it simultaneously introduces significant physiological and psychological stressors ^(1,2). Objectives: This pilot randomized controlled study aimed to examine the feasibility and preliminary efficacy of an Integrated Cognitive and Self-Management Training (ICST) program to improve cognitive function and self-management behaviors among patients with end-stage kidney disease (ESKD) undergoing hemodialysis (HD). Methods: ESKD patients who met the inclusion criteria (n = 20) were randomly assigned to either the experimental group (n = 10) or control group (n = 10). The experimental group received usual care plus the ICST program, comprising 16 sessions (60 minutes each, twice weekly) delivered over 8 weeks during the one-hour pre-dialysis waiting period. Cognitive function and self-management behaviors were assessed using the Montreal Cognitive Assessment-Basic (MoCA-B) and the Self-Management Behavior Questionnaire (SMBQ) at baseline and post-intervention (Week 8). Qualitative feedback on program acceptability was also collected from experimental-group participants through brief open-ended questionnaire items conducted by the research assistant at the final session. Demographic data were summarized using descriptive statistics. Between-group differences were assessed using independent-samples t-tests, while within-group pre–post changes in the intervention group were examined using paired-samples t-tests. Results: The ICST program demonstrated excellent feasibility with a 100% participant retention and attendance rate, and zero adverse events. At post-intervention, the experimental group achieved significantly higher scores than the control group in both cognitive function (26.20 0.63 vs. 25.10 0.57; t = 4.09, p < .001, 95% CI [0.54, 1.67], Cohen's d = 1.83) and self-management behaviors (173.00 10.38 vs. 136.60 26.38; t = 4.06, p < .001, 95% CI [17.56, 55.24], Cohen's d = 1.82). Within-group analysis (experimental group only, n=10) confirmed significant pre- to post-intervention improvements in cognitive function (t₉ = 6.71, p < .001) and self-management behaviors (t₉ = 7.11, p < .001). Qualitative feedback confirmed high acceptability; participants described the program as "clear, practical, and easy to complete." Conclusions: The ICST program was feasible, highly acceptable, and demonstrated large preliminary effects on both cognitive function and self-management behaviors for HD patients. These findings warrant larger-scale randomized controlled trials with longer follow-up periods to confirm long-term clinical benefits and further studies exploring the feasibility of broader clinical implementation across hemodialysis settings.