Objective To investigate the hemoglobin levels of initiating hemodialysis patients and to analyze the risk factors associated with anemia.Methods We retrospectively analyzed a total of 95 chronic kidney disease patients, who underwent initiating hemodialysis in Hefei Second People's Hospital between January 2017 and January 2019. Serum calcium, phosphorus, hemoglobin, albumin, parathyroid hormone (PTH), C-reactive protein, cystatin C, cholesterol, triglyceride, and iron metabolism were measured. Patients were divided into mild, moderate, and severe anemia group, according to hemoglobin levels. The differences of biochemical indicators and other clinical indicators between the three groups were compared. Ordinal multivariate logistic regression analysis was used to analyze the relationship between the severity of anemia and serum CRP, cystatin C, and the history of ESA (erythropoiesis stimulating agents).Results A total of 95 patients on initiating hemodialysis were enrolled in our study. We observed that the mean hemoglobin level was (74.89±18.23) g/L among those subjects. There was no significant difference in albumin, blood glucose, triglyceride, cholesterol, PTH, TCO₂, and ferritin among the three groups (P > 0.05). However, compared with the other two groups, the serum cystatin C level was increased in the severe anemia group (P < 0.05), but there was no significant difference in the cystatin C level between the mild anemia group and the moderate anemia group (P > 0.05). The difference of CRP between mild and moderate anemia group, mild and severe anemia group, and moderate and severe anemia group was statistically significant (P < 0.05). The history of erythropoiesis-stimulating agent (ESA) treatment was significantly lower than the other two groups. However, levels of CRP and cystatin C were not significantly different in the mild anemia group as compared with moderate anemia group. Ordinal multivariate logistic regression showed that CRP [R = 1.351, (95% CI: 1.180, 1.546)], cystatin C [R = 1.727, (95% CI: 1.315, 2.267)], and the history of ESA [R = 0.328, (95% CI: 0.110, 0.977)] treatment were some important factors affecting the severity of anemia.Conclusion The present study reveals that the hemoglobin compliance rate of the initiating hemodialysis patients is low, and the anemia severity is related to CRP, cystatin C, and the history of ESA.