Background <p>Affective disorders contribute to poorer outcomes in hemodialysis patients. We aimed to investigate the association of depression and anxiety with sarcopenia and dynapenia among patients receiving maintenance hemodialysis.</p> Methods <p>A total of 1074 patients (676 men, mean aged 61.3 ± 12.6 years) undergoing hemodialysis from 7 facilities in Shanghai of China from 2020 to 2023. Depression was evaluated by the Patient Health Questionnaire-9 (PHQ-9) and anxiety was assessed by the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7). The cut-off values of muscle mass and muscle function to define sarcopenia, dynapenia, and presarcopenia were according to the consensus by the Asia Working Group of Sarcopenia in 2019.</p> Results <p>Among 1074 participants, 160 (14.9%) had depression, 85(7.9%) had anxiety. Patients were divided into four groups: sarcopenia (<i>n</i> = 211), dynapenia(<i>n</i> = 267), presarcopenia(<i>n</i> = 100), and the robust (<i>n</i> = 496) group. The proportion of depression in the group sarcopenia, dynapenia, presarcopenia and robust were 19.4%, 22.8%, 14.0%, and 8.9% (sarcopenia vs. robust <i>P</i> &lt; 0.001; dynapenia vs. robust <i>P</i> &lt; 0.001; overall p value &lt; 0.001). The proportion of anxiety in the four group were 10.4%, 10.5%, 6.0%, and 5.8%, respectively (overall p value &gt; 0.05). Multivariate analysis revealed that sarcopenia, dynapenia, Malnutrition Inflammation Score (MIS), Charlson Comorbidity Index (CCI) and Fractional clearance index for urea (Kt/V) were significant factors linked to the presence of depression.</p> Conclusion <p>Our findings suggest that sarcopenia and dynapenia are associated with depression rather than anxiety in hemodialysis patients. Interventions or programs aiming to alleviate sarcopenia or dynapenia can be effective strategies to prevent depression in the hemodialysis population.</p>