Abstract: Sarcopenia is highly prevalent among patients undergoing maintenance hemodialysis (MHD) and represents an important clinical problem affecting functional status, quality of life, and long-term prognosis. Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and function. In MHD patients, it is often driven by the combined effects of multiple factors such as chronic inflammation, malnutrition, metabolic disorders, endocrine abnormalities, and dialysis-related stress. Its pathogenesis is complex, its progression is relatively rapid, and its clinical impact is substantial. Given the high prevalence of sarcopenia and its adverse clinical outcomes in the MHD population, a systematic understanding of its pathogenesis, clinical outcomes, and intervention strategies is of great significance for the early identification of high-risk patients in clinical practice. This article reviews the definition, epidemiological characteristics, pathogenesis, clinical outcomes, and intervention and management strategies of sarcopenia in MHD patients, with the aim of deepening the understanding of its clinical significance in this population and providing a reference for clinical prevention and treatment as well as future research.