Various neurological problems of the brain are known to occur in patients with end stage renal disease (ESRD). However, little is known about diffusion tensor imaging (DTI) findings in patients with ESRD. Using DTI, we attempted to investigate DTI findings in patients with ESRD who showed no specific lesions on conventional brain MRI. We recruited 10 consecutive patients with ESRD for whom at least 3 years had passed since the start of peritoneal dialysis and who showed no neurological abnormality on neurologic examination. We excluded 6 patients who showed cerebral infarct (4 patients) and diabetes mellitus with peripheral neuropathy (2 patients); finally, 4 patients (39.75 ± 9.84 years) were included in this study. We evaluated hand motor function and cognition. DTI data were acquired using a 1.5-T Philips Gyroscan Intera system and diffusion tensor tractographies (DTTs) for five neural tracts (corticospinal tract, fornix, superior longitudinal fasciculus, inferior longitudinal fasciculus, and inferior fronto-occipital fasciculus) were evaluated. With the exception of 1 patient who revealed a mild abnormality at a higher cognitive function, no abnormalities in motor and cognitive function were observed. Among the 10 DTTs, except for those of the corticospinal tract, all 4 patients had more than one lesion. Patients with ESRD showed abnormalities on DTTs that were associated with cognition; however, they did not show significant cognitive abnormalities.