Objective: The burden of cognitive impairment in end-stage renal disease (ESRD) undergoing peritoneal dialysis received more attention, which associated with hospitalization, mortality and quality of life. We aimed to assess the topological alterations of brain white matter structural network in ESRD and the correlation between network metrics with Montreal Cognitive Assessment scores and clinical data. Methods: The study included 25 ESRD patients with secondary hyperparathyroidism (SHPT group), 25 patients without SHPT (Non-SHPT group) and 25 healthy controls (HC group) of comparable age and sex. Cognitive function was assessed using Montreal Cognitive Assessment. WM structural network constructed by diffusion tensor imaging and deterministic tractography method, and then used graph theoretical approaches to investigate alterations in the global and regional properties of the WM network in these participants. Results: ESRD patients showed cognitive impairment compared to HC and SHPT patients was lower cognitive scores than Non-SHPT patients. The global topological organization and local efficiency of WM network was significantly disrupted in SHPT but not in Non-SHPT patients, as compared with HC group. Moreover, lower regional efficiency was found in ESRD patients mainly distributed in the frontal and parietal cortices. In addition, association was found between iPTH, shortest path length and cognitive impairment, and iPTH level was negatively correlated with small-worldness by two indexes normalized clustering coefficient and normalized shortest path length. Conclusion: The present study indicated that brain structural connectome in ESRD patients with high iPTH level was disrupted as cognitive impairment and it has the potential connectome-based biomarkers for early detection.