Objective: To investigate the current status and influencing factors of psychosocial adaptation of hemodialysis patients, and to provide a reference basis for the development of nursing interventions. Methods: 435 hemodialysis patients from the hemodialysis centers of three tertiary A hospitals in Xi’an City were conveniently selected from April to August 2023, and were investigated using the General Information Questionnaire, the Psychosocial Adaptation to Disease Scale, the Fear of Disease Progression Simplification Scale, and the Personal Sense of Control Scale. Results: The psychosocial adaptation score of hemodialysis patients was (56.68 ± 18.32); the results of multiple linear regression analysis showed that marital status, the form of payment for medical expenses, work status, degree of self-care in daily life, number of co-morbid chronic illnesses, fear of disease progression, and sense of personal mastery were the main influencing factors of psychosocial adaptation of hemodialysis patients. Conclusion: The psychosocial adaptation of hemodialysis patients is at the level of severe maladaptation, and healthcare professionals should formulate scientific and reasonable nursing intervention programs according to their influencing factors to enhance their psychosocial adaptation.