ABSTRACT objective: Cardiovascular impairment is an important complication of uremia undergoing hemodialysis therapy. Left atrial (LA) deformation is closely related to left ventricular filling pressure and dysfunction, but quantification of LA dysfunction remains a challenge. The purpose of this study was to evaluate the LA function in uremia patients with preserved left ventricular ejection fraction (LVEF) using four-dimensional auto left atrial quantification (LAQ). Methods: Thirty-seven uremia patients on hemodialysis and 34 healthy individuals were enrolled in the study. All participants underwent conventional echocardiographic examinations and LAQ. The measurements of LA dimension, volume, emptying fraction, and longitudinal/circumferential strain parameters during triphasic were obtained from the left ventricular long axis and apical four-chamber views, which were taken offline using software (GE EchoPac 203), and the results of two groups were compared and analyzed. Results: Compared with those of the control group, left ventricular dimension and wall thickness, LA dimension and volume were increased in patients with uremia. LA emptying fraction is decreased but in the normal range. The longitudinal strain during reservoir, conduit and pump phase were significantly lower, while the circumferential strain was lower during reservoir and conduit phases. Conclusion: The myocardial damage in uremia dialysis patients was impaired before the abnormality of LVEF. LA strain is more sensitive than traditional echocardiographic parameters to detect LA structural and functional damage. LAQ provided a new and advanced method, we can further demonstrate and quantify these changes, which could provide useful information for clinical practice.