We read with great interest the meta-analysis by O'Lone et al1 regarding cognitive dysfunction in patients with chronic kidney disease treated with hemodialysis. In this study, the authors concluded that individuals treated with hemodialysis are susceptible to the onset of cognitive dysfunction. Currently, an extensive body of research demonstrates that cognitive dysfunction is highly prevalent in hemodialysis patients.2-4 Unfortunately, the mechanisms are still not fully elucidated. We would therefore like to present a hypothesis regarding a possible mechanism underlying hemodialysis-associated cognitive dysfunction.