Purpose <p>Hemodialysis (HD) patients commonly experience enhanced oxidative stress and inflammation, potentially increasing the risk of malnutrition. Selenium levels are typically lower in HD individuals. Selenium deficiency has been identified as a risk factor for oxidative stress and inflammatory responses. Therefore, we intended to perform a meta-analysis to assess the impact of selenium supplementation on HD patients.</p> Methods <p>PubMed, Embase, Cochrane Library, and Web of Science were searched for randomized controlled trials (RCTs) on the effect of selenium supplementation on HD patients until September 31, 2024. The data analysis was conducted using Stata15.0 software.</p> Results <p>Seven RCTs, with 2080 participants, were finally included, with 1029 in the selenium group and 1051 in the control group. The meta-analysis unraveled no statistically significant impact of selenium supplementation on body mass index (SMD = 0.15, 95% CI (− 0.20, 0.49), triglyceride [(SMD = − 0.02, 95% CI (− 0.44, 0.41)], total cholesterol [(SMD = − 0.18, 95%CI (− 0.41, 0.05)], low-density lipoprotein [(SMD = − 0.37, 95% CI (− 1.04, 0.31)], high-density lipoprotein cholesterol [(SMD = 0.15, 95% CI (− 0.54, 0.84)], C-reactive protein [(SMD = − 0.10, 95% CI (− 0.46, 0.27)], ferritin [(SMD = − 0.02, 95% CI (− 0.29, 0.26)], Hx-C reactive protein [(SMD = 0.00, 95% CI (− 1.02, 1.03)], and hemoglobin [(SMD = 0.01, 95% CI (− 0.57,0.59)]. Only selenium levels were significantly increased after selenium supplementation [SMD = 2.83, 95% CI (2.43, 3.24)].</p> Conclusion <p>Selenium supplementation can increase selenium levels in HD patients, without notable impacts on weight, triglycerides, and total cholesterol.</p>