Background: Cardiovascular impairment is an important complication of end-stage renal disease (ESRD) undergoing hemodialysis (HD) therapy. Left atrial (LA) deformation is closely related to left ventricular (LV) filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in ESRD patients using four-dimensional(4D) auto left atrial quantification(4D-LAQ). Methods: Thirty-seven ESRD patients (aged 51.68±15.98 years; 43% male) on HD and 34 healthy individuals (aged 42.03±11.50 years; 38% male) were enrolled in the study. All participants underwent conventional echocardiographic examinations and 4D-LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the LV long axis and apical 4-chamber views, which were taken offline using software (GE EchoPac 203). Results: In patients with ESRD, LA dimension and volume were higher than the healthy group, while the LASr (22.54±6.14 vs 33.74±5.07; p<0.05), LAScd (-12.54±5.83 vs -20.03±5.21;p<0.05), LASct (-10.00±4.93 vs -13.56±5.17;p<0.05 ), LASr-c (28.00±6.61 vs 35.29±7.24;p<0.05), and LAScd-c (-13.27±5.58 vs -18.47±8.65; p<0.05) were significantly lower. Furthermore, a good positive correlation was observed between the LAEF, LASr, and LAScd-c values and LV filling pressure, which reflect diastolic dysfunction. Conclusion: We demonstrated that the LA strain in dialysis patients was impaired before the occurrence of LA dilation. LA strain is more sensitive than traditional echocardiographic parameters, and LASr and LAScd-c may be useful to detect early myocardial involvement.