Objective To analyze the latent categories and influencing factors of death anxiety among patients undergoing maintenance hemodialysis (MHD), and to provide a reference for conducting targeted nursing interventions. Methods From June to August 2025, a total of 329 MHD patients from the blood purification center of a grade A tertiary hospital were selected by using a conve-nience sampling method. Then they were investigated by utilizing a general information questionnaire, the Death Anxiety Scale, the Self-Perceived Burden Scale, the Family APGAR Index, and the Social Isolation Scale. Latent profile analysis was performed to identify the potential categories of death anxiety. Results The participants′ total score of death anxiety was 55.00 (47.00, 59.00). Death anxiety could be divided into three latent categories: low-level-emotionally calm type (15.50%), moderate-level-adaptive adjustment type (26.75%), and high-level-emotional stress reaction type (57.75%). Multivariate logistic regression analysis revealed that age, personal monthly income, self-perceived burden, and social isolation were significant influencing factors of the latent categories of death anxiety (all P<0.05). Conclusion Death anxiety in MHD patients presents distinct category characteristics.Medical staff should develop targeted interventions based on the influencing factors of these categories,so as to effectively reduce MHD patients′ death anxiety.