【Abstract】Objective To study the risk factors for the death of maintenance hemodialysis (MHD) patients and to explore the strategies for the increase of survival rate in MHD patients. Methods We used registration data and system records from five hemodialysis centers including Shanghai Changzheng Hospital, Peking University People’s Hospital, People's Hospital of Guangxi Zhuang Autonomous Region, Peking University Third Hospital and Zhong Da Hospital. The mortality rate and the information of the died MHD patients including gender, age, dialysis duration, dialysis method, primary disease, complications, use of iron and erythropoiesis stimulating agent (ESA) were collected in these cases in the period from January 1, 2016 to December 31, 2017. Statistic analyses were conducted after verification of the data. Results The total number of MHD patients in the five hospitals was 2,022, with a total of patient-months of 40,753 months. There were 289 died cases, and the two-year mortality rate was 14.3%. The annual mortality was 85.1 per 1,000 patient years after adjustment of the patient-months. The mortality rate in patients with dialysis duration of 3～3.9 years (11.1%) was the highest, followed by those with dialysis duration ＜1.0 year (10.4%). The main causes of death were cardiovascular disease (32.6%), infection (23.3%), cerebrovascular events (12.3%), tumor (8.8%), and hemorrhagic disease such as gastrointestinal bleeding (7.9%). Iron agents were used in 210 cases (72.7%) and ESAs were used in 269 cases (93.1%). The utilization rate of combined iron agent and ESA reached 93.4%. Conclusions The issue of the high mortality in MHD patients should be greatly considered, especially in patients with the dialysis age of 3.0～3.9 years and ＜1.0 year. The risk factors for mortality included cardiovascular and cerebrovascular diseases, infection, bleeding and anemia. These complications should be actively prevented and treated.