Objective To explore the prevalence of frailty and its influencing factors among elderly maintenance hemodialysis (MHD) patients in China by a meta-analysis, and to provide references for early diagnosis and intervention of the frailty.  Methods  We systematically searched for the databases of Embase, Cochrane Library, PubMed, WOS, CINAHL, SinoMed, CNKI, VIP and WanFang. The search period was from the establishment of the database to April 2024. Meta-analysis was performed using the Stata 15.0 software.  Results  A total of 11 literatures were obtained, containing 1008 patients with frailty in the 2007 elderly MHD patients, and 28 related influencing factors. Meta-analysis found that the prevalence of frailty in elderly MHD patients in China was 48% (95% CI: 37.2%～58.9%). Age (OR=1.163, 95% CI: 1.066～1.269, P=0.001), female (OR=2.143, 95% CI: 1.296～3.543, P=0.003), C-reactive protein (OR=1.331, 95% CI: 1.124～1.576, P=0.001), depression (OR=4.231, 95% CI: 1.524～11.751, P=0.006), complicated with diabetes (OR=3.242, 95% CI: 1.943～5.410, P＜0.001) and complicated with cardiovascular disease (OR=4.066, 95% CI: 2.225～7.430, P＜0.001) were the risk factors for frailty in elderly MHD patients in China. Ability of daily living (OR=0.886, 95% CI: 0.791～0.993, P=0.037) was a protective factor for frailty in elderly MHD patients in China.  Conclusion  The prevalence of frailty in Chinese elderly MHD patients is at a higher level. Clinical staff should pay attention to elderly MHD patients, identify the influence factors for frailty, and take individualized intervention measures, so as to achieve early recognition, prevention, treatment and a higher survival rate.