Objective To evaluate the changes level of amino terminal brain natriuretic peptide(NT-proBNP) as well as its relationship between the changes and cardiac function classification in elderly maintenance hemodialysis patients with congestive heart failure. Methods Self-reflection Methods was used to analyze clinical data in 36 maintenance hemodialysis patients with congestive heart failure (hemodialysis heart failure group)aged≥60 years and compared with 38 non-maintenance hemodialysis patients with congestive heart failure (control group)aged≥60 years whose estimated glomerular filtration rate (eGFR) ＞60 ml/(min·1.73 m²) more than 60 years old among the same period in this hospital. The NT-proBNP level of different grades classified by NYHA (New York Heart Association) in the two group’s patients was measured after the treatment to improve cardiac function. ROC curve was used to evaluate diagnosis efficiency of NT–proBNP in different cardiac function classification of hemodialysis heart failure group. Results In hemodialysis heart failure group, compared with control group, NT-proBNP level of various cardiac function classification, median NT-proBNP values of Ⅰ, Ⅱ, Ⅲ, Ⅳ cardiac function classification respectively were significantly higher (P<0.05 or P<0.01). Comparing NT-proBNP level between different heart function classification in hemodialysis heart failure group, adjacent grading levels Ⅱ-Ⅳ also had significant difference (P<0.05 or P<0.01), and levels Ⅰ-Ⅱ have no significant difference (P>0.05). The same comparison in control group, adjacent grading levels Ⅰ-Ⅳ all have significant differences (P<0.05 or P<0.01). AUC value Results in hemodialysis heart failure group: AUC value in grade Ⅳ was 0.847, NT-proBNP>11 100 ng/L as boundary values, sensitivity was 83%, specificity was 79%; AUC value in grade Ⅲ was 0.794, NT-proBNP> 6465 ng/L as boundary values, sensitivity was 100%, specificity was 56.4%; cardiac function classification Ⅰ, Ⅱ were meaningless. Conclusions NT- proBNP can be regarded as diagnostic index and grading index of Ⅲ Ⅳ in elderly hemodialysis patients with congestive heart failure.