AbstractIntroduction: Previous studies have revealed abnormal resting‐state brain activity in patients with end‐stage renal disease (ESRD); however, the results are inconsistent. Thus, we conducted a coordinate‐based meta‐analysis of whole‐brain resting‐state functional neuroimaging studies in ESRD to identify the most consistent neural activity alterations in ESRD patients and explore their relation to serological indicators.Methods: A comprehensive literature search strategy was applied to select pertinent studies up to December 2022 in PubMed, Web of Science, and Embase databases. Voxel‐wise meta‐analysis was conducted via the latest meta‐analytic algorithm, seed‐baseddmapping with permutation of subject images software. Meta‐regression analyses were also conducted to explore the potential effect of clinical variables on resting‐state neural activity.Results: Eleven studies comprising 304 patients with ESRD and 296 healthy controls (HCs) were included. Compared with HCs, ESRD patients showed decreased brain activity in the default mode network (DMN) regions, including the bilateral anterior cingulate cortex/medial prefrontal cortex, bilateral midcingulate cortex/posterior cingulate cortex, bilateral precuneus, and right angular gyrus. The neural activities in the bilateral midcingulate cortex, bilateral midcingulate cortex/posterior cingulate cortex, and right angular gyrus were significantly associated with serological indexes including hemoglobin, urea, and creatinine levels.Conclusion: The present study provides a quantitative overview of brain activity alterations in patients with ESRD, and the results confirm the essential role of the DMN in ESRD patients, which may be the potential neural basis of their cognitive deficits. Additionally, some serological indicators may be used as predictive markers for progressive impairment of brain function.