Objective  To investigate the association of serum homocysteine (Hcy) and ferritin (SF) with sarcopenia in maintenance hemodialysis (MHD) patients.  Method  undergoing MHD at Huzhou Central Hospital between January 2023 and January 2024 were retrospectively collected. Patients with sarcopenia (n=40, 32.00%) were assigned to the sarcopenia group, while those without sarcopenia (n=85, 68.00%) comprised the non-sarcopenia group. Baseline characteristics, laboratory parameters, and serum Hcy and SF levels at admission were collected. Logistic regression was used to identify factors influencing sarcopenia in MHD patients.  Results Compared with the non-sarcopenia group, the sarcopenia group showed significantly higher levels of high-sensitivity C-reactive protein (hs-CRP), Hcy and SF (t =4.400, 5.169, 5.650; all P＜0.001) and lower levels of hemoglobin, skeletal muscle mass index, handgrip strength and gait speed (t=4.901, 3.764, 3.300, 3.870; P＜0.001, ＜0.001, 0.001, ＜0.001, respectively). Logistic regression revealed that elevated hs-CRP (OR =2.100, 95% CI:1.313～3.357, P=0.002), Hcy (OR=1.160, 95% CI: 1.073～1.255, P＜0.001) and SF (OR =1.018, 95% CI:1.009～1.027, P＜0.001) were independent risk factors for sarcopenia, whereas higher hemoglobin level (OR=0.930, 95% CI: 0.885～0.978, P=0.004) was a protective factor.  Conclusion   Elevated serum Hcy and SF levels are independent risk factors for sarcopenia in MHD patients..