【Abstract】Objective To explore the risk factors of fall accident in maintenance hemodialysis (MHD) patients and to design nursing intervention measures to prevent it happening. Methods A cross-sectional study was conducted in 102 adult patients undergoing MHD in Xuanwu Hospital of Capital Medical University from December 2017 to May 2018. Basic information, educational level, vital signs and the history of falls in the recent one year were collected through clinical sampling and questionnaires. Barthel Index Scale was used to assess daily living ability, Simple Intelligence Status Scale was used to assess cognitive function, and Morse Fall Assessment Scale was used to assess falls. χ2 test and independent sample t test were used to compare the differences of these indexes between patients who experienced falls and those did not in the recent one year. Univariate and multivariate logistic regression models were used to evaluate the risk factors affecting falls in MHD patients. Results The average age (t=2.737, P=0.007) and fall score (t=3.201,P=0.002) in patients with falls were higher than those without falls. The rates of cognitive impairment and moderate living impairment in patients with falls were higher than those without falls (χ2=14.925,P＜0.001), while the proportion of severe living impairment was higher in patients without falls (χ2=11.399,P=0.003). Logistic regression model found that cognitive impairment was the risk factor for falls in MHD patients, and the risk of falls in normal cognitive patients was 0.233 times that in cognitive impairment patients (P＜0.01, 95% CI 0.094～0.577). Conclusions Cognitive impairment is a key factor affecting falls in MHD patients. Intensive nursing care is crucial for cognitive impairment patients to prevent falls.