Objective To analyze the correlation and predictive value of platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR) and erythropoietin (EPO) in patients undergoing maintenance hemodialysis (MHD). Methods 121 patients with maintenance hemodialysis admitted to our hospital from February 2020 to February 2023 were selected as the study objects, including 62 patients in the low EPO resistance index (ERI) group and 59 patients in the high ERI group. The XN series fully automatic five-differentiation hematology meter was used to detect platelets, lymphocytes, and neutrophils, and the general information and laboratory indicators were collected, multivariate binary Logistic regression equation to analyze the independent risk factors affecting EPO resistance. The correlation between PLR, NLR and ERI was analyzed by Pearson. ROC curve was used to analyze PLR, NLR single or combined predictive value of ERI. Results There were no significant difference in age, gender, dialysis months, white blood cells, platelets, lymphocytes, neutrophils, calcium, phosphorus, parathyroid hormone, iron, ferritin, albumin and urea nitrogen between the low ERI group and the high ERI group (P＞0.05). There were statistically significant differences in body mass index, hemoglobin, PLR, NLR and creatinine between the two groups after dialysis (P＜0.05). Logistic regression analysis found that post-dialysis body mass index, hemoglobin, PLR, NLR and creatinine were independent risk factors for EPO resistance (P＜0.05). The pearson results showed that PLR, NLR and ERI (r=0.987, 0.978, P＜0.05) were positively correlated. The sensitivity and specificity of PLR+NLR were 84.27%, 80.33%, AUC 0.725 and 95%CI 0.631-0.809, respectively. Conclusion PLR and NLR are independent risk factors affecting the occurrence of EPO resistance in MHD, and are correlated with ERI, the combination of PLR and NLR has high predictive value for ERI, and early detection of PLR and NLR is conducive to reducing EPO resistance