Objective To explore the trajectory of nutritional literacy changes in maintenance hemodialysis patients analyze the influencing factors of different trajectories and explore the correlation with frailty so as to provide new ideas and bases for the improvement of the patients' level of frailty at a later stage. Method Convenience sampling method was used to select patients undergoing maintenance hemodialysis treatment in Jiangsu Provincial People's Hospital during the time period from January 2023 to June 2024 as the study subjects and basic information questionnaire Chinese version of the Nutritional Literacy Assessment Tool and the Tilburg Debilitation Scale were used to conduct questionnaire surveys on the enrolled research subjects. The data were analyzed and tested by one - way analysis and two - by - two comparison. Result The total nutritional literacy score of maintenance hemodialysis patients was 20. 21±4. 37 points and the debilitation score 4. 55±1. 13 points. Nutritional literacy of maintenance hemodialysis patients was categorized into 3 potential profile categories high nutrient literacy group low nutrient literacy group and medium nutrient literacy group. Univariate analysis the 3 category groups were significantly different in terms of age education mode of residence and age on dialysis P < 0. 05 . Two-by-two comparison showed that the level of debilitation of patients in the low-nutrient literacy group was higher than that of the high-nutrient literacy group P < 0. 01 and higher than that of the medium-nutrient literacy low-skill group P < 0. 01 and that of the medium-nutrient literacy low-skill group was higher than that of the high-nutrient literacy group P < 0. 05 . Conclusion Nutritional literacy of maintenance hemodialysis patients was classified into 3 potential profile categories. Nutritional literacy in different profiles was strongly associated with the patients' level of debilitation. Clinical staff can actively adopt countermeasures for patients in the low-literacy group to improve their nutrient literacy status as much as possible which will have a positive effect on delaying the progression of patients' debilitation and preventing the occurrence of adverse events.