Malignant arrhythmia is an important cause for death in maintenance hemodialysis (MHD) patients. Auria,low potassium dialysate and potassium accumulation during dialysis can cause plasma potassium fluctuations in MHD patients. Increased electrophysiological instability of the heart induce malignant arrhythmia. Additionally,there are high prevalence of structural cardiac changes and ischemic heart diseases in MHD patients,making them more susceptible to acute arrhythmogenic triggers. Therefore,the management of potassium homeostasis is particular importance in MHD patients. This review focused on the risk factors and intervention strategy of fluctuation in plasma potassium in MHD patients.