This systematic review and meta-analysis determined the global prevalence of poor sleep quality in hemodialysis (HD) patients. It included 69 studies with a total of 14,998 HD patients. The pooled global prevalence of poor sleep quality was 64.2% (95% CI: 60.5–67.8%). Studies were searched in seven databases up to 20 October 2025 and assessed for quality using the JBI tool, with 55 studies at low risk of bias and 14 at moderate risk. Subgroup analyzes showed differences according to cut-off values, but meta-regression did not confirm a significant effect of sample size, mean age, duration of dialysis, or proportion of women. The conclusion emphasizes the need for screening and evidence-based interventions to mitigate adverse effects.