Metabolic syndrome (MetS), a cluster of cardiometabolic risk factors, is highly prevalent among patients with chronic kidney disease (CKD), particularly those undergoing hemodialysis (HD). This study investigated the prevalence, characteristics, and clinical implications of MetS among Sudanese HD patients at Kassala and Al-Gadarif Kidney Centers in Eastern Sudan. A hospital-based case–control study was conducted between September 2021 and June 2024, enrolling 70 HD patients and 70 age- and sex-matched healthy controls from each center. Key metabolic parameters—including waist circumference, blood pressure, fasting blood glucose, and lipid profiles (triglycerides and HDL cholesterol)—were assessed. MetS was diagnosed according to the International Diabetes Federation (IDF) criteria. The findings showed that 38% of Kassala HD patients and 42% of Al-Gadarif HD patients fulfilled the diagnostic criteria for MetS. Compared to controls, HD patients from both centers had significantly higher waist circumference, systolic and diastolic blood pressure, fasting blood glucose, and triglyceride levels (p < 0.0001). HDL cholesterol was markedly lower (p < 0.0001). Patients in Al-Gadarif exhibited slightly higher renal and metabolic abnormalities—including elevated urea, creatinine, waist circumference, blood pressure, triglycerides, and fasting glucose—alongside lower HDL cholesterol compared with Kassala patients, suggesting a heavier metabolic burden. These results underscore the heightened cardiovascular risk among Sudanese HD patients, with Al-Gadarif patients demonstrating a marginally greater prevalence of MetS. Early detection, regular monitoring, and comprehensive management strategies—including lifestyle modifications, pharmacological therapy, and region-specific interventions—are urgently needed to reduce cardiovascular morbidity and mortality in this vulnerable population.