【Abstract】 Objective To study plasma total homocysteine (tHcy) level, the factors affecting tHcy level, and the relationship between tHcy level and cardiovascular disease (CVD) in hemodialysis patients. Methods We observed 65 maintenance hemodialysis (MHD) patients and 30 healthy volunteers in this study. Their CVD was recorded, and plasma tHcy was measured by fluorescence polarization immunoassay. Results Hyperhomocysteinemia was detected in 89.2% MHD patients. Plasma tHcy level was higher in patients with CVD than in those without CVD. Plasma tHcy, triglycerides and pre-albumin were significantly different between patients with CVD and those without CVD (P＜0.05), but other biochemical parameters had no differences between the two patient groups (P＞0.05). Hyperhomocysteinemia correlated with body weight gain in the dialysis period, plasma albumin and plasma triglycerides. The incidence of CVD was higher in patients with diabetes than those without diabetes (P＜0.05). However, tHcy levels showed no difference between patients with CVD and those without CVD (P＞0.05). Multiple stepwise regression analysis demonstrated that hyperhomocysteinemia was the risk factor for CVD, and pre-albumin was the protective factor for CVD in MHD patients. Conclusion Hyperhomocysteinemia is frequently seen in MHD patients, and is a risk factor for CVD in these patients.