This systematic review and meta-analysis determined the global prevalence of frailty in hemodialysis patients to be 39.6% (95% CI 35–44%). The analysis included 64 studies from 10 countries with a total sample of 23,799 patients. Prevalence varied significantly by sample size, age, duration of hemodialysis, gender, year of publication, diagnostic criteria, and geographic region. Meta-regression confirmed that sample size, age and gender were independent predictors of frailty prevalence. Frailty in hemodialysis patients is associated with a higher risk of hospitalization, mortality, and falls. The studies were searched in databases such as Web of Science, Scopus and Chinese databases until June 15, 2023. The authors recommend early screening and interventions against frailty in routine care.