Increased fear of falling (FOF) increases the risk of falling and is an important issue for living an independent life.���Patients undergoing hemodialysis (HD) frequently fall, and this may be attributed to increased FOF due to common fall risk factors as well as severe chronic kidney disease and HD-related factors.���The purpose of this narrative review was to summarize the current knowledge on the mechanisms of increased FOF leading to falls in patients undergoing HD.���Patients undergoing HD have enhanced FOF compared to community elderly people.���Furthermore, an increase in FOF is correlated with a decrease in physical activity and physical function.���It has been reported that FOF in patients undergoing HD may be associated with past and future falls, and the risk of falling increases sharply when FOF exceeds a certain threshold.���Increased FOF may serve as a fundamental mechanism leading to increased fall risk by interacting with physical inactivity and physical frailty, affecting lower limb muscle activity during walking.���Further research is needed to clarify the relationship between increased FOF and falls in patients undergoing HD.���Regular clinical assessment of FOF is critical for identifying fall risk in patients undergoing HD.
