Objective To investigate the incidence and possible influencing factors of secondary relative hypoparathyroidism (SRHOP) in the patients with maintenance hemodialysis (MHD). Methods Totally 182 stable chronic renal failure patients with MHD for more than 3 months were selected from the Blood Purification Center of Shanghai 7^th People’s Hospital from January 2012 to December 2012. The status of plasma intact parathyroid hormone (iPTH) was analyzed according to the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines. The patients were divided into two groups according to plasma iPTH concentrations: SRHOP group (iPTH<150 pg/mL, n=73) and non-SRHOP group (iPTH ≥ 150 pg/mL, n=109). The influencing factors for the SRHOP of MHD patients were investigated by Spearman correlation analysis and Logistic regression analysis. Results The average concentration of plasma iPTH of 182 MHD patients was (173.5±114.3) pg/mL, and the concentration decreased gradually with age. According to KDIGO guidelines, the concentrations of plasma iPTH reached the standard in 83 cases (45.6%), lower than the standard in 73 cases (40.1%), and higher than the standard in 26 cases (14.3%). The concentrations of plasma iPTH were not significantly different between the genders. The age, incidence of diabetes, and plasma corrected calcium concentration of the SRHOP patients were significantly higher, while the plasma phosphorus, albumin and normalized protein equivalent of nitrogen appearance (nPNA) levels were significantly lower than those of the non-SRHOP patients (P<0.05). There were no significant differences in gender composition, duration of dialysis, blood pressure, plasma urea nitrogen, plasma creatinine, urea clearance index (Kt/V), numbers of patients with oral calcium or vitamin D, and hemoglobin between the two groups. Spearman analysis showed that age, diabetes, plasma corrected calcium, and phosphorus and albumin levels were associated with SRHOP, and Logistic regression analysis indicated that the age and plasma phosphorus level of MHD patients were independent risk factors for SRHOP. Conclusion SRHOP, rather than secondary hyperparathyroidism, often occurs in MHD patients. The patient age and plasma phosphorus level are the independent risk factors for SRHOP.