Objective To explore the mediating role of psychological resilience between financial toxicity and quality of life in young and middle-aged patients with chronic kidney failure undergoing hemodialysis, and to provide a reference for improving patients′ quality of life.Methods Convenience sampling was used to select 326 young and middle-aged chronic kidney failure hemodialysis patients from October 2023 to April 2024.Data were collected using a general information questionnaire, the Connor-Davidson Resi-lience Scale, Comprehensive Scores for Financial Toxicity Based on the Patient-Reported Outcome Measures (COST-PROM), and the Kidney Disease Quality of Life Short Form.Structural equation modelling was employed for analysis.Results The median financial toxicity score was 21.00 (14.00,28.00), psychological resilience score was 48.00(39.00,57.00), and quality of life score was (51.33±13.85).Financial toxicity negatively predicted quality of life.Psychological resilience played a mediating role between financial toxicity and quality of life, with the mediating effect accounting for 42.38% of the total effect.Conclusion Psychological resilience partially mediates the impact of financial toxicity on quality of life among young and middle-aged hemodialysis patients.Nursing staff can implement targeted interventions to alleviate patients′ financial toxicity, improve psychological resilience, and thereby promote quality of life.