Objective To investigate the incidence of frailty and analyze its influencing factors in the elderly patients undergoing maintenance hemodialysis (MHD). Methods A cross-sectional study was conducted in 130 elderly inpatients or outpatients receiving regular MHD in the Second Affiliated Hospital of Anhui Medical University from October 2021 to April 2022. The general information, laboratory indicators, and anthropometric parameters were collected. Fried frailty phenotype was used to assess frailty. The two groups were compared in the general information, laboratory indicators, fall risk, activities of daily living, nutrition status, and anthropometric parameters. SPSS statistics 26.0 was used for data analysis. Depending on data type, comparison between groups was performed using t test, Man-Whitney U test, orχ² test. Partial correlation analysis was used to analyze the correlation between frailty score and each index, and multivariate stepwise logistic regression analysis to explore the influencing factors of frailty in the elderly MHD patients. Results The incidence of frailty was 40%(52/130) in the elderly MHD patients. Correlation analysis showed that frailty was positively correlated with malnutrition-inflammation score (MIS), Morse falling scale (MFS), C-reactive protein (CRP) (r=0.521,0.330,0.236; P<0.05) and negatively with Barthel index (BI), mid-arm muscle circumference (MAMC), serum albumin (Alb), and hemoglobin (Hb) (r=-0.424, -0.438, -0.478, -0.332; P<0.001) . Multivariate logistic stepwise regression analysis showed that MIS score (OR=1.156,95%CI 1.002-1.333; P=0.047), Alb (OR=0.851,95%CI 0.687-0.931; P=0.013), BI (OR=0.972,95%CI 0.947-0.988; P=0.032), and age (OR =1.107,95%CI 1.018-1.204; P=0.017) were influencing factors for frailty in the elderly MHD patients. Conclusion The incidence of frailty is high in the elderly MHD patients. MFS, MIS score and CRP are positively correlated with frailty, while the BI, Hb, Alb and MAMC are negatively correlated with frailty. Alb and BI are protective factors of frailty, and age and MIS score were risk factors of frailty.