There is increasing understanding of the burden of cognitive impairment in patients receiving maintenance dialysis, with upward of 70% of prevalent patients affected.1 Cognitive impairment affects virtually every aspect of health care, including adherence, decision making, advance care planning, quality of life, and mortality. Educational attainment is a marker of socioeconomic status, can influence health outcomes, may modify the presentation of clinical cognitive impairment or dementia, and has been linked to mortality in the general population.