Objective to investigate the relationship between cerebrovascular reactivity(CVR)and emotional disorders in the patients undergoing continuous hemodialysis for end-stage renal disease(ESRD).Methods the clinical data of the ESRD patients undergoing continuous hemodialysis were collected.anxiety and depression of the patients were assessed by the Hamilton anxiety scale(HAMA)and Beck depression inventory,respectively.the cerebral hemodynamic changes during the breath holding test were monitored by transcranial Doppler sonography,and the breath-holding index(BHI)was calculated.the BHI≥0.69 and BHI<0.69 indicate normal CVR and abnormal CVR,respectively.Binary Logistic regression was employed To analyze the factors affecting the depressive state of ESRD patients.Results the group with abnormal CVR exhibited higher total cholesterol level(P=0.010),low density lipoprotein level(P=0.006),and incidence of depression(P=0.012)than the group with normal CVR.Compared with the non-depression group,the depression group displayed prolonged disease course(P=0.039),reduced body mass index(P=0.048),elevated HAMA score(P=0.001),increased incidence of anxiety(P<0.001),decreased BHI(P=0.015),and increased incidence of abnormal CVR(P=0.012).Binary Logistic regression analysis indicated anxiety as a contributing factor(OR=22.915,95%CI=2.653-197.956,P=0.004)and abnormal CVR as a risk factor(OR=0.074,95%CI=0.008-0.730,P=0.026)for depression.Conclusion Impaired CVR could pose a risk for depression in the patients with ESRD。