<p>Although several studies have indicated a connection between cortical and subcortical structural abnormalities and sleep disturbances (SD) in patients with end-stage renal disease undergoing hemodialysis (HD), detailed characterization of these abnormalities remains unclear. In this study, twenty HD patients with SD (HD-SD), 20 HD patients without SD (HD-NSD) and 22 healthy controls were recruited and underwent clinical assessments, neuropsychological tests, and 3.0T MRI scans. Vertex-based analyses of cortical thickness, surface area and volume were conducted to examine cortical abnormalities between groups. Volumetric and vertex-wise shape analyses were performed to identify volumes and surfaces of subcortical structures. Correlations examined relationships between gray matter metrics, clinical data, and cognitive performance. ROC curve analyses were performed to identify metrics that differed between HD subgroups. Our results show that HD-SD patients exhibited cortical abnormalities in the frontal, temporal and parietal cortices, while HD-NSD patients showed abnormalities only in the frontal cortex. Both HD groups demonstrated subcortical morpho-volumetric changes in the hippocampus, basal ganglia, and thalamus, with right hippocampal contraction best differentiating HD-SD from HD-NSD. In HD patients, higher Pittsburgh Sleep Quality Index (PSQI) scores and more severe renal impairment were associated with cortical atrophy and subcortical shape alterations. Other neuropsychological markers in HD patients, including attention, working memory and negative emotions, shared cortical abnormalities mainly in the frontal and occipital cortex. Accordingly, our findings highlight the importance of distinguishing HD subgroups based on sleep quality, as this may provide valuable insights into the neurodegenerative mechanisms in this population.</p>