Background/Aim: Emerging evidence on lowering dialysate temperature suggests a cardiorenal protective effect of Dialysate Cooling (CD) against dialysis-induced ischemia in hemodialysis (HD) patients prone to Intradialytic Hypotension (IDH). Whether this benefit of CD could be extended to incident HD population without baseline IDH to preserve Residual Kidney Function (RKF) is unknown. Methods: One hundred incident HD patients were randomly assigned to receive either incremental CD 36 ℃ (intervention, N=50 patients) or standard temperature (ST) dialysate (control, N=50 patients) for 12 months. The primary endpoint was to test the safety and efficacy of CD to preserve RKF. Results: By the end of 12-months, CD patients had less decline in eGFR compared to ST patients (6.2 vs 4.6 ml/min/1.73 m2, p-value 0.025), additionally Cox regression analysis showed that CD was an independent variable for the preservation of RKF (P-value 0.044, HR 0.478, CI: 0.23-0.89). CD was well tolerated with less fatigue and IDH; however, coldness, shivering, and discomfort were significantly higher in the CD group. Conclusion: In incident HD patients without baseline IDH, Cooled Dialysis might help preserve RKF with a reasonable safety profile. Further studies are warranted to explore these findings.