【Abstract】Objective To investigate the clinical features, diagnosis, treatment and prognosis of active tuberculosis in patients undergoing hemodialysis (HD). Methods The clinical data of 36 HD patients with active tuberculosis and treated in the period from Jan. 1, 2014 to Jan. 1, 2018 in our hospital were studied retrospectively. Their survival rates were expressed using Kaplan-Meier curve. Log-rank test and Cox regression model were used to analyze their prognosis. Results The chief clinical manifestations were fever (58.33%) and extra-pulmonary tuberculosis (72.22%) in the 36 patients. The diagnosis was made by the combination of bacteriological and histological methods in 16 cases (44.44%), and by clinical manifestations and other examinations in 20 patients. Nineteen patients (52.78%) developed the side-effects of anti-tuberculosis drugs, including peripheral neuropathy, retro-bulbar neuritis and digestive disorders. Eleven patients (30.56%) died in the follow- up period from 3 days to 48 months. Univariate analyses showed that albumin ＜35g/L (P=0.011), age ≥60 years (P＜0.005) and comorbidities ≥ 2 (P=0.022) were closely related to unfavorable prognosis. Cox regression analysis showed that age was the independent risk factor for prognosis in HD patients with active tuberculosis (P=0.022). Conclusion There were no specific manifestations in HD patients with active tuberculosis. The incidence of side-effects of anti-tuberculosis drugs was higher and the prognosis was poorer in these patients. Nutritional status, age and comorbidities were the important risk factors for prognosis.