Abstract: Objective To analyze the effect of iron metabolism on the changes in cardiac structure and function in maintenance hemodialysis (MHD) patients.Methods This study enrolled 91 MHD patients between Jan. 1, 2016 and Dec. 31, 2016 at Hemodialysis Center of Zhongnan Hospital of Wuhan University. They were recruited with general information, laboratory results and Doppler echocardiography. According to the Kidney Disease:Improving Global Outcomes (KDIGO) guidelines, the patients were divided into low iron metabolism group, target-iron metabolism group and high iron metabolism group. The general information, laboratory results and Doppler echocardiography results were observed, and the relationship between the target-iron status and the changes of cardiac structure in MHD patients was analyzed.Results Hemoglobin level was the lowest in low iron metabolism group (P<0.05), the target-hemoglobin rate was the highest in target-iron metabolism group (P=0.015), and there was no significant difference in the rest laboratory results among three groups. In Logistic regression analysis, Doppler echocardiography revealed that advanced age and high phosphorus were risk factors for valvular calcification (CVC); advanced age, low hemoglobin and high SF were risk factors for left ventricular hypertrophy (LVH). Moreover, CVC, age and Alb were correlated with the development of LVH under the low iron metabolism conditions, however, high SF was risk factor for LVH under the high iron metabolism conditions. The prevalence of LVH (14.29%) was lowest in target-iron metabolism group (P=0.003), the transmitral E/A ratio was lowest in high iron metabolism group (P=0.015), but the prevalence of CVC and the left ventricular ejection fraction (LVEF) showed no significant difference among three groups.Conclusions The target-iron metabolism rate was closely correlated with the development of LVH in MHD patients.Whether low iron metabolism or high iron metabolism,LVH and cardiac function will be changed in MHD.