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慢性肾脏病是常见的慢性疾病，患者常伴有认知障碍，可进展为痴呆症，严重影响患者的生活质量及疾病自我管理。本文从肾脑轴角度出发，分别阐述了血管内皮功能受损、炎症反应引起的脑神经损伤、脑结构与功能改变、脑血流动力学失衡、脑代谢紊乱及肾脏替代治疗对认知功能的影响，以期全面介绍慢性肾脏病患者认知障碍发生机制的最新研究进展。“,”Chronic kidney disease (CKD) is a common chronic disease, often accompanied by cognitive impairment (CI), which can progress to dementia. CKD-induced cognitive impairment (CKD-CI) seriously affects the patient's quality of life and disease self-management. From the perspective of kidney-brain axis, this article elaborates on the damage of vascular endothelial function, oxidative stress, endoplasmic reticulum stress, and inflammation caused by brain nerve damage, brain structure and function changes, cerebral hemodynamic imbalance, brain metabolic disorders and renal replacement therapy affect cognition mechanisms from pathophysiological, neuroimmunological and neuroimaging. This is a review of recent advance in the mechanism of cognitive impairment in CKD.