Background <p>Major adverse cardiovascular and cerebrovascular events (MACCE) are the primary cause of poor prognosis and mortality in patients with end-stage renal disease (ESRD), posing a serious threat to their health. Investigating the risk factors for MACCE in long-term hemodialysis patients with ESRD is of great significance for improving treatment outcomes and patient prognosis.</p> Methods <p>Peripheral blood samples were collected from participants, and RT-qPCR was employed to measure the expression levels of miR-632 and PKD1. Participants were followed for three years. The clinical significance of miR-632 in predicting the occurrence of MACCE was analyzed using Kaplan-Meier survival curves, multivariate logistic regression, and ROC curves.</p> Results <p>In patients with ESRD undergoing long-term hemodialysis, the expression level of miR-632 is significantly elevated. This high expression is strongly associated with an increased incidence of MACCE. miR-632 has high predictive value for the occurrence of MACCE in ESRD patients.</p> Conclusions <p>miR-632 is a risk factor for MACCE in ESRD patients undergoing long-term hemodialysis.</p>