Introduction: Chronic kidney disease-mineral and bone disorder (CKD-MBD) is frequently observed in maintenance hemodialysis (MHD) patients, and is associated with fracture, muscle weakness, malnutrition, etc.; however, relationships of CKD-MBD markers and fatigue are not well established. Methods: This was a cross-sectional study included 244 MHD patients (89 elders) from July to September 2021 in The First Affiliated Hospital of Shandong First Medical University. CKD-MBD markers and other clinical data were collected from medical records. Fatigue in the past week was measure by Standardized Outcomes in Nephrology-Hemodialysis (SONG-HD) fatigue measure; fatigue at the end of hemodialysis was measure by numeric rating scale (NRS). Spearman correlation, linear regression and robust linear regression were. Results: In all MHD patients, Lg(25(OH)D(nmol/L) were negatively correlated with SONG-HD score (β=-1.503, 95%CI: -2.826--0.18, P=0.026) and NRS score (β=-1.532, P=0.04) in multiple regression models adjusting for sex, age and all CKD-MBD characters; but no correlations were found on univariate regression or in other multiple regression models. Interactions effects between age≥65years and Lg(25(OH)D(nmol/L)) in terms of fatigue scores were significant base on multiple linear regressions (SONG-HD score β=-3.613, P for interaction =0.006; NRS score β=-3.943, P for interaction=0.008). Compared with non-elderly patients, elderly patients were with higher ACCI scores(7(6, 8) VS 4(3, 5), P

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