Background <p>This study investigated the prevalence of presenteeism and its associated factors in employed patients undergoing maintenance hemodialysis (HD).</p> Methods <p>A single-center cross-sectional study was conducted involving 33 employed HD patients in Japan. Presenteeism was assessed using the work functioning impairment scale (WFun). Additional evaluations included hemoglobin (Hb) levels, exercise self-efficacy (SE), physical function (grip strength, 10-m walk test, and the short physical performance battery [SPPB]), and dialysis-related parameters. Correlation and multiple regression analyses were performed to identify independent predictors.</p> Results <p>Presenteeism was present in 39.4% of participants. WFun scores showed significant negative correlations with Hb levels, exercise SE scores, and SPPB scores. Multiple regression analyses revealed that lower Hb and SE scores were independently associated with higher WFun scores after adjustment for covariates.</p> Conclusions <p>Presenteeism in HD patients is linked to anemia and low exercise SE. Addressing these factors may support continued employment.</p>