Objective：To identify the prevalence of cerebral lesions in maintenance hemodialysis（MHD） patients without cognitive im－pairment，analyze the potential risk factors，and preliminarily investigate the relationship between the cerebral lesions and their cognitive function/depression. Methods：A cross-sectional study was conducted on 30 MHD patients without cognitive impairment and 30 healthy controls，and the brain magnetic resonance imaging findings were compared between the two groups of patients. Demographic information and laboratory data were collected. The Montreal cognitive assessment（MoCA） and Beck depression inventory（BDI） were used to evaluate their cognitive function and depression. A logistic regression analysis was performed to identify the risk factors for cerebral lesions. The Mann-Whitney U test was used to evaluate the differences in cognitive function and depression between the MHD patients with and without cerebral lesions. Results：Among the 30 MHD patients without cognitive impairment，16（53.33%） had cerebral lesions，including lacunar infarctions in 11（36.67%） cases，leukoencephalopathy in 6（20.00%） cases，and multiple ischemic lesions in 7（23.33%） cases，versus 2 cases of cerebral lesions in the control group（ χ2=15.556，P=0.000）. The logistic regres－sion analysis showed that serum phosphate was an independent risk factor for lacunar infarctions（OR=12.297，95%CI=1.106 to 136.737，P<0.05） and multiple ischemic lesions（OR=77.492，95%CI=1.571 to 3 822.433，P<0.05） in MHD patients without cognitive impairment. The MoCA score was significantly higher in MHD patients without cerebral lesions than in those with cerebral small vessel diseases（lacunar infarctions and multiple ischemic lesions，Z=-2.10，P=0.036） and those with leukoencephalopathy（Z=-2.13，P=0.038），while the BDI score was not significant between them. Conclusions：More than half of the MHD patients without cognitive impairment have cerebral lesions，such as lacunar infarc－tions，multiple ischemic lesions，and leukoencephalopathy. Serum phosphate is an independent risk factor for cerebral small vessel diseases. Cerebral small vessel diseases and leukoencephalopathy are associated with cognitive function decline in MHD patients.