show Abstracthide AbstractGrowing evidence has demonstrated that patients undergoing peritoneal dialysis (PD) are more likely to have cognitive impairment than patients with pre-dialysis end-stage renal disease (ESRD), and the underlying mechanisms have not been fully elucidated. This study aimed to determine the role and predictive value of gut microbiome alterations in patients with PD-associated cognitive impairment.A total of 29 pre-dialysis ESRD patients and 28 PD patients were enrolled in this study and classified into subgroups according to the Montreal Cognitive Assessment (MoCA). Faecal samples were analyzed using 16S rRNA. A MoCA score < 26 indicated cognitive impairment. After scoring, the ESRD group was subdivided into 17 patients with normal cognition (NCI) and 12 patients with cognitive impairment (CI), while the PD group was subdivided into 9 patients with normal cognition (PNCI) and 19 patients with cognitive impairment (PCI).