Objective  To understand the clinical situation of patients with stage 5 chronic kidney disease (CKD) during the first hemodialysis in Mianzhu area, so as to provide a basis for continuous improvement of CKD management before dialysis.  Methods  A single-center retrospective study was performed, which recruited patients with stage 5 CKD and undergoing first hemodialysis (HD) in Mianzhu People's Hospital from January 2014 to December 2019. They were divided into hypertension group and normal blood pressure group. Their clinical data at the first hemodialysis were recorded. Laboratory indicators, primary renal disease, and dialysis access modality were compared between the two groups.   Results   A total of 185 patients were included in this study. The top 3 primary diseases were chronic glomerulonephritis (79 cases), diabetic nephropathy (61 cases) and hypertensive renal damage (22 cases); the top 3 complications were renal anemia (178 cases), hypertension (171 cases) and renal osteopathy (104 cases). The main reasons for hemodialysis were uremic symptoms, similar in both groups (χ2=2.937, P=0.087). Serum phosphorus was higher in normal blood pressure group than in hypertension group (t=-1.990, P=0.048), while serum high-density lipoprotein cholesterol was lower in the normal blood pressure group than in hypertension group (t=2.070,   P=0.040). Blood access modality had no difference between the two groups (χ2=0.000, P=0.985).  Conclusion  Chronic glomerulonephritis was the most important primary disease in stage 5 CKD patients at first hemodialysis in Mianzhu area. Uremic symptoms were the most common causes for the beginning of hemodialysis. Renal anemia, hypertension, and CKD-mineral and bone disorder (CKD-MBD) were the most common complications in these patients.