Background <p>Cardiovascular disease (CVD) is a major complication in patients on maintenance hemodialysis (MHD). While the effect of left ventricular dysfunction on patients on MHD is well known, the association between right ventricular (RV) dysfunction and their prognosis remains poorly understood.</p> Methods <p>We conducted a retrospective cohort study of 149 patients on MHD (median age, 72&#xa0;years; male, 67%) between 1 April 2022 and 31 March 2024. All subjects underwent transthoracic two-dimensional and Doppler echocardiographic examination. RV dysfunction was determined when the tricuspid annular plane systolic excursion (TAPSE) was under 16&#xa0;mm. Kaplan–Meier survival analysis was used to compare survival between patients with and without RV dysfunction. Multivariate Cox regression analyses were used to estimate the effects of RV dysfunction on all-cause mortality, including the effect of confounding factors such as age, sex, previous CVD events, and left ventricular (LV) dysfunction.</p> Results <p>In total, 20 out of 149 patients on MHD (13%) had RV dysfunction. Indexes of their LV function (such as the LV ejection fraction and E/e' ratio) were similar to those of patients without RV dysfunction. During the follow-up period, 23 patients died (7 with RV dysfunction [without LV dysfunction], 3 with LV dysfunction [without RV dysfunction], 2 with biventricular dysfunction, and 11 without any ventricular dysfunction). Kaplan–Meier analyses showed significantly lower survival among patients with RV dysfunction (<i>p</i> &lt; 0.01). The multivariate Cox regression analysis revealed that RV dysfunction (without LV dysfunction) was independently associated with all-cause mortality (hazard ratio: 3.44; 95% confidence interval: 1.28–9.23) after adjusting for confounders.</p> Conclusions <p>RV dysfunction is a significant risk factor for all-cause mortality among patients on MHD.</p>