The growing public health burden of nondialysis chronic kidney disease (CKD) as the population ages is mirrored by concomitant cerebrovascular and neurodegenerative aging changes on brain magnetic resonance imaging (MRI) and associated cognitive impairment in CKD. Cerebrovascular changes in CKD are demonstrated by microvascular white matter changes; decreased white matter integrity, reflecting microvascular disease in the kidney; and micro- and macroinfarcts. Neurodegenerative changes are represented by decreased cortical gray matter volume, or atrophy of the cerebral lobes (especially temporal and frontal in Alzheimer disease [AD] and related dementias), and enlarged ventricular volume.