The study examined the relationship between fluctuations in hemoglobin levels and mortality in 652 hemodialysis patients in a Chinese hospital. The researchers analyzed four parameters representing hemoglobin variability: standard deviation, residual standard deviation, coefficient of variation and abnormal hemoglobin ratio. The results of univariate analysis showed statistically significant differences between patients who survived and those who died, especially in mean hemoglobin level, coefficient of variation and abnormal hemoglobin ratio. ROC curve analysis showed that abnormal hemoglobin ratio had the highest hazard ratio (HR = 2.30), followed by hemoglobin coefficient of variation (HR = 2.12) and residual standard deviation (HR = 1.88). Multivariable Cox regression confirmed that these three parameters of hemoglobin variability are independent factors associated with mortality in hemodialysis patients. The results remained consistent even in the subgroup of patients with at least ten blood count tests.