Background:Poor muscle quality has been associated with mortality in patients undergoing hemodialysis (HD). Handgrip strength (HGS) has gained considerable attention as a marker of nutritional status and muscle function. The aim of this study was to verify the association between HGS and mortality in patients undergoing maintenance HD in Taiwan.Methods: A total of 188 stable HD patients from January to December 2009 were enrolled in the study. We used a standard handgrip dynamometer to measure the HGS. HGS was measured on enrolment at the beginning of the study. Each measurement was repeated three times for each patient, and the average value was recorded for analysis.Results: During a mean follow-up period of 47 ± 11 months, 34 of the 188 patients died. The all-cause mortality rate was 18%. Higher HGS (hazard ratio [HR] 0.891, 95% confidence interval [CI] 0.838–0.948; p < 0.001) and Kt/V (HR 0.086, 95% CI 0.018–0.421; p = 0.002) were independent factors associated with survival in HD patients. For female patients, an HGS < 17 kg had a positive predictive value (PPV) of 39% and a negative predictive value (NPV) of 96% for predicting mortality. For male patients, an HGS < 26 kg had a PPV of 29% and an NPV of 84% for predicting mortality.Conclusion: HGS provides a good marker for survival in HD patients. Our results indicate that HGS can identify male and female patients undergoing maintenance HD with an increased risk of all-cause mortality, with different cut-off values for each sex.