Cognitive impairment is a major cause of morbidity in people with chronic kidney disease (CKD) and is associated with worse survival. Prior data suggest a relationship between vascular disease and cognitive impairment in individuals with CKD. Clinicians should be aware of the high rates of cognitive impairment that occur in all stages of CKD, which, although sometimes subtle, may impact comprehension and decision making and may herald future, more debilitating impairment.