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.