Abstract: Objective:To investigate the Effects of Roxadustat on Cognitive Function in Patients Undergoing Maintenance Hemodialysis and Its Potential Mechanisms. Methods:A total of 355 patients undergoing regular hemodialysis at four tertiary hospitals between April 2023 and April 2024 were enrolled.They were divided into the Roxadustat group and the erythropoietin group based on their anemia medication.General information,laboratory indexes,plasma HIF-1α,ADAM10,and Aβ levels were collected from the two groups,and plasma HIF-1α,ADAM10,and Aβ levels were detected by ELISA;patients'cognitive functions were assessed by the MoCA scale.Propensity-matched scores were used to balance the imbalance between groups at baseline,and mediated effect models were used to analyze whether Roxadustat affected patients'cognitive functions through the HIF-1α/ADAM10/Aβ pathway. Results:After propensity score matching,there were no statistically significant differences between the two patient groups in baseline hemoglobin levels, age, years of education, hypertension, diabetes, or duration of dialysis (P>0.05); compared with baseline, the total MoCA score,visuospatial and executive,verbal,abstract,and delayed recall scores were higher in the Roxadustat group than in the baseline after 6 months of follow-up, with statistically significant differences (P<0.05); the delayed recall score was higher in the Roxadustat group than in the Erythropoietin group,and the difference was statistically significant (P=0.016); the ffet of Roxadustat on MoCA scores was not signiicant through the estimated value of the mediating effect of HIF-1α,ADAM10,and Aβ. Conclusion:Patients in the Roxadustat group demonstrated significant improvement in MoCA scores after 6 months of treatment compared to baseline,with superior gains in the delayed recall domain relative to the erythropoietin group.