Objective To investigate the effect of a refined management based on ORTCC model in maintenance hemodialysis patients with sarcopenia. Methods Sixty-two patients with sarcopenia who underwent MHD in our hospital from February to June 2022 were divided into control group (n=31) and intervention group (n=31). The control group was given routine nursing care. The intervention group was given a refined management mode based on the ORTCC model. Refined management was implemented around five elements: objective, rules, training, check and culture. Skeletal muscle mass, muscle strength, physical function and patients′ mastery of knowledge related to maintenance hemodialysis sarcopenia were evaluated after 6 months of intervention. Results The scores of skeletal muscle mass index, upper arm muscle circumference and simple physical function scale, the grip strength, walking speed and knowledge holding rate in the intervention group were significantly higher than those in the control group (P<0.05 for all). Conclusion The refined management mode based on the ORTCC model can improve the related indexes of sarcopenia, improve body function, enhance patients′ knowledge mastery, and contribute to the accurate management of patients.