〔Abstract〕 Objective To study the correlation between cerebral white matter structure with cognitive function and blood biochemical indexes in patients with end stage renal disease(ESRD). Methods The diffusion tensor imaging(DTI) data of 64 ESRD patients and 47 age and sex matched healthy people were collected. Tract-based spatial statistics(TBSS) and XTRACT analysis methods were used to compare the differences in diffusion parameters between the two groups. Pearson correlation analysis was used to detect the correlation between various diffusion parameters and blood biochemical indexes and cognitive related scales. Results The values of FA in the ESRD group generally decreased(P<0.05). The values of MD, AD and RD obviously increased(P<0.05). The scores of mini mental state examination(MMSE) and Montreal cognitive assessment(MoCA) decreased(P<0.01), while that of trail making test A part(TMT-A) increased(P<0.05). In the ESRD group, the values of FA in the right anterior thalamic radiation, optic radiation, acoustic radiation, and cingulum were negatively correlated with thelevels of creatinine and urea nitrogen, and positively correlated with MoCA′s scores, and the values of MD and RDof these tracts were positively correlated with the concentration of urea. The values of FA in optic radiation, acous-tic radiation and left temporal of cingulum were negatively correlated with the scores of TMT-A. The values of FA inthe vertical occipital fasciculus, inferior fronto-occipital fasciculus, left middle longitudinal fasciculus and forcepsmajor were negatively correlated with the concentration of creatinine. The values of FA in the left arcuate fasciculuswere positively correlated with the MoCA′s score, the values of MD and RD of these tracts were positively correlatedwith the concentration of creatinine, and negatively correlated with the scores of MMSE and MoCA. The values ofFA in the right superior longitudinal fasciculus, the right corticospinal tract and the right frontal aslant tract werepositively correlated with the MoCA′s score, the values of MD and RD of these tracts were positively correlated withthe concentration of urea; the values of MD and RD in the left fornix were positively correlated with the level of cre-atinine and urea.Conclusion The structural integrity of white matter in ESRD patients is extensively damaged,which is significantly associated with a variety of cognitive impairments. Serum creatinine and urea nitrogen may berisk factors for the changes in white matter.