Objective: To investigate the association of short-term blood pressure variability (BPV) with cardiovascular mortality in hemodialysis (HD) patients, using a reliable index called average real variability (ARV), and to assess the factors associated with ARV in incident HD population.Methods: A total of 103HD patients were recruited, with 44-h ambulatory blood pressure monitoring performed after the midweek HD session. Systolic BPV was assessed by SD, coefficient of variation (CV), and ARV, respectively. Laboratory data were obtained from blood samples before the midweek HD. All patients were followed up for 24 months.Results: According to the median of BPV indices, the comparisons between patients with the low and high values were conducted. Kaplan-Meier analysis showed the survival curves corresponding to median of SD and CV exhibit similar performance for the low and high groups (p=.647, p=.098, respectively). In contrast, patients with higher ARV had a lower survival rate than those with lower ARV (77.8% vs. 98.0%, p=.002). After adjustment for demographics and clinical factors, ARV (HR: 1.143; 95% CI: 1.022-1.279, p=.019) and high-sensitivity C-reactive protein (HR: 1.394; 95% CI: 1.025-1.363, p=.021) were associated with increased risk of cardiovascular mortality in HD patients. Age and interdialytic weight gain (IDWG) were related factors for ARV (=0.065, p=.005; =0.825, p=.003, respectively).Conclusions: Greater ARV was independently associated with increased risk of cardiovascular mortality in HD patients. Age and IDWG were independent related factors for ARV.