End-stage renal disease (ESRD) is associated with a complex interplay of malnutrition, inflammation, and anemia, significantly affecting patient outcomes. This review discusses the impact of malnutrition-inflammation syndrome on anemia among hemodialysis patients. ESRD patients experience systemic inflammation, marked by elevated levels of pro-inflammatory markers such as C-reactive protein (CRP) and cytokines (IL-6, TNF-α), contributing to immune deficiency, cardiovascular complications, and anemia. Malnutrition in chronic kidney disease (CKD) is characterized by protein energy wasting (PEW) and micronutrient deficiencies, resulting from metabolic disturbances, poor nutrient absorption, and dialysis-related factors. These nutritional deficits exacerbate anemia, primarily due to decreased erythropoietin production and impaired red blood cell synthesis. Inflammation further suppresses erythropoiesis and accelerates protein catabolism, leading to muscle wasting and increased mortality risk. Additionally, CKD patients exhibit altered gut microbiota and gastrointestinal dysfunction, such as delayed gastric emptying, which worsens their nutritional status. The dialysis procedure itself induces inflammatory responses, aggravating malnutrition and anemia. Managing these interrelated issues requires a multidisciplinary approach that addresses both nutritional support and inflammation control. This review highlights the critical need for early identification and intervention strategies to mitigate malnutrition and inflammation, thereby improving anemia management in hemodialysis patients. Comprehensive care, including tailored nutritional plans and anti-inflammatory therapies, can enhance patient outcomes and quality of life.