Abstract: Objective To investigate the effect of total glucosides of peony (TGP) on the micro-inflammation of patients with maintenance hemodialysis (MHD) and its underlying mechanism. Methods The clinical data of 60 patients with MHD and 30 healthy individuals were collected. The fasting venous blood was gathered before and after the experiment, and the content of hemoglobin (Hb), albumin (Alb), alanine aminotransferase (ALT), aspartate aminotransferase (AST) and high-sensitivity C-reactive protein (CRP) was detrmined by biochemical analyzer. Enzyme-linked immunosorbent assay (Elisa) was employed to detect the levels of IL-6, TNF-α and neutrophil gelatinase-associated apolipoprotein (NGAL). Simultaneously, real-time fluorescence quantitative polymerase chain reaction (RT-PCR) was applied to examine Toll-like receptor 4 (TLR4) and myeloid differentiation factor 88 (MyD88). Results As compared with the normal control group, the levels of CRP(6.6±2.3) vs. (1.2±1.4) mg/L, IL-6(351.2±42.3) vs. (55.3±8.4) ng/L, TNF-α(8.5±3.2) vs. (2.3±2.1) ng/L and NGAL(548.3±37.8) vs. (52.1±5.7) ng/mL in peripheral blood of MHD patients were significantly elevated (P<0.05). After treatment wiht TGP, the above indexes(4.2±2.3) vs. (6.8±2.7) mg/L,(298.5±52.7) ng/L vs. (349.2±50.2) ng/L,(7.3±3.3) vs. (8.8±3.1) ng/L and(440.6±42.0) vs.(549.92±42.84) ng/mL were significantly lower than those before treatment (P<0.05). The contents of TLR4(2.35±0.16)vs. (1.30±0.18) and MyD88 mRNA(3.62±0.21) vs. (1.58±0.15) in peripheral blood of MHD patients were remarkably higher than those in the normal control group (P<0.05). After the administration of TGP, the TLR4(1.28±0.14) vs. (2.42±0.24) and MYD88 concentration(1.64±0.24) vs. (3.68±0.19) was appreciably decreased as compared with those before treatment (P<0.05). Conclusions The TGP may improve the micro-inflammation of MHD patients by inhibiting the TLR4/MYD88/NF-κB signaling pathway, thus exerting protective effect on patients with MHD.