Patients on maintenance hemodialysis are in a state of persistent low-grade microinflammation. The accumulation of pro-inflammatory cytokines and middle-large molecular uremic toxins is closely associated with cardiovascular events, protein-energy wasting, and deteriorated quality of life. Conventional hemodialysis has limited capacity to remove middle-large molecular inflammatory mediators, and may even aggravate inflammatory responses due to bioincompatibility. Based on adsorption mechanism, hemoperfusion combined with conventional dialysis can eliminate uremic toxins such as β-microglobulin and inflammatory mediators including interleukin-6 and tumor necrosis factor-α, and to some extent regulate immune cell activation and ameliorate the imbalance of immune cell subsets. This article reviews the pathological basis of microinflammation in maintenance hemodialysis patients, as well as the mechanism, combined modalities, and clinical research progress of hemoperfusion, so as to provide references for the optimization of blood purification strategies.