Abstract: Objective To investigate the influencing factors and quality of life of maintenance hemodialysis (MHD) patients with restless leg syndrome (RLS). Methods A total of 190 MHD patients from the Blood Purification Center of Affiliated Yantai Yuhuangding Hospital of Qingdao University between December 2023 and February 2024 were selected. According to the international diagnostic criteria for RLS, the patients were divided into two groups: a RLS group (n=59) and a non-RLS group (n=131). Both groups were compared for general information and laboratory data. Univariate and multivariate logistic regression analyses were used to identify the influencing factors for RLS in MHD patients. The Pittsburgh Sleep Quality Index (PSQI), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Malnutrition Inflammation Score (MIS) were used to assess the impact of RLS on the quality of life of MHD patients. Results Univariate analysis showed statistical differences between the two groups in the presence of hypertension (P=0.009) and diabetes (P=0.002), with the etiology of diabetic nephropathy (P<0.001) and chronic nephritis (P=0.008), age (P=0.011), γ-glutamyl transferase (P=0.027), blood phosphorus (P=0.024), and blood glucose (P<0.001). Multivariate logistic regression analysis indicated that hyperphosphatemia (OR=2.193, 95%CI:1.245-3.865, P=0.007), hypertension (OR=5.599, 95%CI: 1.397-22.439, P=0.015), and hyperglycemia (OR=1.206, 95%CI: 1.054-1.381, P=0.007) were independent risk factors for RLS in MHD patients. Additionally, significant differences were found in SAS, SDS, and PSQI scores between the two groups (P<0.05). Conclusions The prevalence of RLS is relatively high in MHD patients. Hyperphosphatemia, hypertension, and hyperglycemia may promote the occurrence of RLS. MHD patients with RLS are more prone to anxiety, depression, and sleep disturbances, with the severity of depression and sleep disorders correlated with the severity of RLS.