Background: Cognitive impairment is a common and clinically significant complication in patients undergoing peritoneal dialysis, a vulnerable population with multiple comorbidities. However, its underlying determinants remain incompletely understood. Vascular calcification, as a marker of systemic vascular pathology, has been suggested to be associated with cognitive dysfunction. This study aimed to evaluate the relationship between intracranial and valvular calcification and cognitive dysfunction in peritoneal dialysis patients. Methods: This single-center cross-sectional study included patients receiving peritoneal dialysis. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). Intracranial and valvular calcifications were determined based on imaging findings. Clinical, demographic, and laboratory parameters were analyzed. Logistic regression analysis was used to identify factors associated with cognitive dysfunction, and receiver operating characteristic (ROC) analysis was performed to assess discriminative performance. Results: A total of 95 patients were included. Patients with cognitive dysfunction were older and more frequently female. In univariate analysis, age, female sex, and mitral valve calcification were significantly associated with cognitive dysfunction. After multivariable adjustment, only age (OR: 1.06, p = 0.02) and female sex (OR: 3.4, p = 0.03) remained independently associated. ROC analysis showed limited discriminative performance (AUC: 0.63). Conclusions: Calcification parameters were associated with cognitive dysfunction in unadjusted analyses but did not remain independent predictors after adjustment. Age was the strongest factor associated with cognitive dysfunction, while female sex was also independently associated with increased risk. These findings suggest that calcification burden may reflect cumulative vascular aging and comorbidity rather than serving as a standalone predictor of cognitive impairment.

Peritoneal dialysis (PD) is a well-established kidney replacement therapy that offers greater treatment flexibility and better preservation of residual kidney function than conventional hemodialysi...