Objective To investigate the impact of hemodialysis blood flow rate（BFR）on outcome in elderly maintenance haemodialysis（MHD）patients. Methods Retrospective analysis was carried out focusing on the general clinical data of 221 elderly MHD patients with in⁃center hemodialysis from December 2012 to December 2020. Elderly MHD patients was subgrouped into high⁃BFR（BFR > 211 mL/min）and low⁃BFR（BFR ≤ 211 mL/min） groups based on the median hemodialysis BFR level. Results Compared with the low BFR group，high BFR patients were younger，longer durations on dialysis，had higher proportion of males，high⁃flux dialyzer，BMI and systolic blood pressure. The hemoglobin level in high BFR was higher than that in low BFR group. Compared with the low BFR group，high BFR patients were younger，longer durations on dialysis，had higher proportion of males， high⁃flux dialyzer，BMI and systolic blood pressure. The hemoglobin level in high BFR was higher than that in low BFR group. Cardiovascular diseases is the leading cause of mortality. There were no statistically significant differ⁃ ences in the survival⁃time and mortality between the two groups. Multivariable Cox regression analysis showed that each 10ml/min BFR increase was associated with a 28.5%（HR：1.285，CI：1.011 ~ 1.635，P = 0.040）increase in the relative risk of death，which is more pronounced in patients with shorter durations on dialysis，dialysis access was central venous catheterization，low hemoglobin，hyperphosphatemic，and a history of coronary artery disease. Conclusion BFR was an independent risk factor of mortality in MHD patients.