Objective To explore the effect of low serum phosphorus and parathyroid hormone (PTH) levels on protein-energy wasting (PEW) in patients on maintenance hemodialysis (MHD) and provide a new method of nutritional monitoring and intervention in patients on MHD. Methods Four hundred end-stage renal disease (ESRD) patients on MHD for at least 3 months were selected from 17 dialysis units. Logistic regression analysis was used to analyze the relationship between serum phosphorus and PTH levels and

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... risk. Receiver operating characteristic (ROC) analysis was used to compare the predictive value of these two indices for PEW. We used the survival curve to analyze the effects of low serum phosphorus and PTH levels on mortality. Results In the unadjusted model, The PEW risk in group Q1 was 16.4 times higher than that in group Q4. Compared with group Q4 of PTH, the PEW risk in groups Q1 and Q2 of PTH was 2.817 times higher and 2.087 times higher, respectively, after adjusting. However, serum phosphorus and PTH levels were associated with PEW risk. PEW risk in the serum phosphorus Q1 group was 7.305 times higher than that in the Q4 group, and PEW risk in the PTH Q1 group was 2.75 times higher than that in the Q4 group. ROC analysis showed that the areas under the curve of serum phosphorus and PTH predicting PEW in MHD patients were 0.862 and 0.695, respectively, while the cut-off values of ROC curve were 1.36 mmol/L and 212.5 ng/L, respectively. The survival rate was significantly lower in patients with serum phosphorus ≤ 1.36 mmol/L of ≤ 212.5 ng/L. Conclusion Low serum phosphorus and PTH levels increased the incidence of PEW and death and seriously affected the prognosis of patients on hemodialysis. Therefore, The nutritional status of patients on MHD can be monitored and evaluated by integrating serum phosphorus, PTH, albumin, and body mass index.