Objective To investigate the correlation between 3.0T MRI diffusion functional imaging in white matter and cognitive function in maintenance dialysis patients. Methods A total of 63 cases of end-stage renal disease (ESRD) patients as study group, 28 cases of healthy persons as control group, all received conventional MR, DWI and DTI examination. DWI and DTl were used to quantify the apparent diffusion coefficient (ADC) and the fractional anisotropy(FA) of white matter in the frontal lobe, temporal lobe, parietal lobe, occipital lobe, internal capsule, corpus callosum, and the hippocampus. All the research object using the Chinese version of the Montreal cognitive assessment scale score (C-MoCA), namely normal (C-MoCA≥26 points), mild cognitive dysfunction (26 points ＞C-MoCA ≥21 points), severe cognitive dysfunction (21 points ＞C-MoCA), control group and the levels between pairwise statistical comparisons were performed. Pearson correlation coefficients were calculated to quantify statistically significant areas of ADC and FA values and the correlation of C-MoCA score. Results Of the 63 patients undergoing maintenance dialysis, 23 had normal cognitive function, 28 cases belonged to mild cognitive impairment, 12 cases with severe cognitive impairment. The ADC and FA values of frontal lobe, parietal lobe and white matter in the study group were statistically different from those in the control group, between the levels of C-MoCA ADC and FA values also exist statistical difference (P<0.05). The ADC values of the frontal lobe and parietal lobe of the study group were negatively correlated with the C-MoCA score. The FA values of the frontal lobe and parietal lobe of the study group were positively correlated with the the C-MoCA score. Conclusion Diffusion functional imaging can be quantitatively, sensitively reflected the characteristics of white matter lesions in maintenance dialysis patients and these changes are related to cognitive function．This helps the early diagnosis of cognitive impairment and improve the quality of survival in patients with ESRD.