Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction occurring during the use of heparin-based drugs, characterized by a decline in platelet count and/or thrombosis. Patients undergoing hemodialysis (HD) may be at higher risk of developing HIT than the general population due to long-term, repeated exposure to heparin preparations, and are more prone to life-threatening thrombotic events. However, there is currently no specific consensus or guideline for the management of HIT in the HD population either domestically or internationally, leading to difficulties in diagnosis, insufficient testing capacity, and inconsistent treatment strategies in clinical practice. To address these issues, a multidisciplinary expert committee comprising nephrologists, cardiovascular physicians, and clinical pharmacists developed recommendations for the prevention and treatment of HIT specifically applicable to the HD population. Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and Delphi method expert voting, the committee systematically integrated domestic and international evidence-based medicine on HIT and clinical experience in HD. The recommendations cover the definition, risk factors, pathogenesis, clinical manifestations, diagnosis and differential diagnosis, screening strategies, anticoagulation therapy and monitoring, special treatments, and management of heparin re-exposure. This consensus aims to provide evidence-based guidance for standardized HIT management in HD patients, enhance clinical awareness and vigilance of the disease, reduce the rate of missed diagnosis and thrombotic mortality, and ultimately improve patient outcomes.