Objective  To explore whether left heart structure constitutes a risk factor for pulmonary hypertension (PH), and the relationship between changes of left heart structure and pulmonary artery systolic pressure (PASP) in maintenance hemodialysis (MHD) patients.  Methods   A total of 80 MHD patients aged 18 to 80 years old and treated in The Second Affiliated Hospital of Wannan Medical College between January 2016 and June 2019 were enrolled in this study. PASP >35mmHg measured by echocardiography was diagnosed as HP. Patients were then divided into two groups: PH group (n=31) and non-PH group (49). They were followed up for 1.5 years for their prognosis. Clinical and laboratory data were analyzed by univariate and multivariate regression tests to understand the influencing factors for PASP and the risk factors for PH in MHD patients.  Results   Pearson correlation test showed that PASP was positively correlated with left atrial diameter (r=0.464, P<0.001), left ventricular systolic diameter (r=0.267, P=0.019), inter-dialysis body mass growth rate (r=0.452, P<0.001), total cholesterol (r=0.469, P<0.001), low-density lipoprotein (r=0.270,          P<0.001), and triacylglycerol (r=0.402, P=0.016), and was negatively correlated with left ventricular ejection fraction (r=-0.235, P=0.040), monthly dialysis time (r=-0.469, P<0.001), hemoglobin (r=-0.300, P=0.005), serum albumin (r=-0.792, P<0.001), and elderly nutritional risk assessment index (r=-0.324, P=0.003). Multivariate logistic regression found that left atrial diameter (OR=1.757, 95% CI:1.164~2.653, P=0.007) and inter-dialysis body mass growth rate (OR=1.296, 95% CI:1.074~1.564, P=0.007) were the independent risk factors for PH.  Conclusion  Changes of left heart structure were closely related to PH in MHD patients. Changes of PASP were associated with the changes of left atrial structure, elderly nutritional risk assessment index, inter-dialysis body mass growth rate, monthly dialysis time, and blood lipids. Enlargement left atrial diameter and increase of inter-dialysis body mass growth rate were the independent risk factors for PH in MHD patients.