Interventions Made to Preserve Cognitive Function

This will be a two by two factorial, randomized, controlled trial to slow cognitive decline
in adults undergoing hemodialysis (HD). The investigators primary objective is to determine
if receiving cognitive training (tablet-based brain games), exercise training (stationary
foot pedal), or combined cognitive and exercise training preserves executive function
relative to those with standard of care . The secondary objectives are to compare the rates
of end stage renal disease (ESRD)-specific clinical outcomes and patient centered outcomes
among those receiving CT, or ET, or CT+ET relative to those in SC. The investigators will
formally test whether receiving CT or ET will preserve executive function and receiving
combined CT+ET will preserve executive function better than CT or ET alone.

Inclusion Criteria:

- 18 years or older at enrollment

- English speaking

- within 3 months to 3 years of initiating hemodialysis

- receiving hemodialysis at participating dialysis centers

Exclusion Criteria: Patients with the following conditions will be excluded:

- Pregnancy

- Angina Pectoris

- Chronic lung disease requiring oxygen

- Musculoskeletal conditions that limit mobility

- Upper or lower extremity amputation

- Orthopedic disorders exacerbated by physical activity

- Femoral arteriovenous (AV) access

- Hepatitis B infection

- Blindness/Legal blindness

In addition to conditions outlined above, patients who are currently incarcerated will be
excluded from the study.