Background To analyze the value of real-time shear wave elastography (SWE) multi-point measurement in the evaluation of muscle elasticity in patients with end-stage renal disease (ESRD) complicated with sarcopenia. Methods We enrolled 169 ESRD patients treated as the research objects from January 2019 to February 2022. According to whether they were complicated with sarcopenia, the patients were divided into sarcopenia group (n=63) and non-sarcopenia group (n=106). The Young's modulus and shear wave velocity (SWV) of muscles in relaxed and contracted states were measured by SWE technology in the two groups. Results Logistic regression analysis showed that age and hs-CRP were independent risk factors for sarcopenia in ESRD patients (P<0.05), while BMI, muscle thickness, Young's modulus in stretched state and SWV in stretched state were protective factors for sarcopenia in ESRD patients (P<0.05). BMI, muscle thickness, Young's modulus in extended state, SWV in extended state and Young's modulus in rest state were all negatively correlated with age and hs-CRP (P<0.05), while there was a significant positive correlation between age and hs-CRP (P<0.05). Independent influencing factors were used to construct the prediction model of nomogram. The consistency index (C-index) was 0.845 (95% CI: 0.8300.857), and the AUC of ROC curve was 0.852 (95% CI: 0.8360.871), which had good discrimination. Conclusion SWE could accurately evaluate the muscle elasticity of ESRD patients, so as to reflect the changes of muscle mass and stiffness of patients, and could provide the important imaging indicator for the prediction of sarcopenia.