Objective To investigate the clinical efficacy and safety of sucroferric oxyhydroxide in the treatment of hyperphosphatemia in maintenance hemodialysis (MHD) patients with inadequately controlled serum phosphorus levels.  Methods  A retrospective analysis was performed on 90 MHD patients from four tertiary hospitals in Shanxi Province between May 2024 and December 2025. All patients had persistent hyperphosphatemia (serum phosphorus＞1.78 mmol/L) despite standard phosphate binder therapy and were switched to sucroferric oxyhydroxide for 12 weeks. A self-controlled, before-and-after design was employed to monitor serum phosphorus (P) levels at baseline and at 2, 4, 8 and 12 weeks after treatment initiation. Iron metabolism parameters were assessed at baseline and after 12 weeks of treatment, and adverse events occurring during treatment were recorded.  Results Among the 90 MHD patients treated with sucroferric oxyhydroxide, the mean age was (51.88±12.95) years, and the mean dialysis vintage was (56.01±48.39) months. The primary underlying diseases included chronic glomerulonephritis in 44 patients (48.89%) and diabetic nephropathy in 20 patients (22.22%). The median baseline serum phosphorus levels were 2.360 (2.118, 2.658) mmol/L. Serum phosphorus levels at all follow-up time points were significantly lower than the baseline level (Week 2: Z=6.081, adjusted P＜0.001; Week 4: Z=10.465, adjusted P＜0.001; Week 8: Z=13.081, adjusted P＜0.001; Week 12: Z=12.327, adjusted P＜0.001). The serum phosphorus target achievement rate reached 83.33% at Week 8 and 85.56% at Week 12. After 12 weeks of treatment, serum ferritin levels were significantly higher than at baseline (t=2.934, P=0.004). Although transferrin saturation (t=1.170, P=0.245) and serum iron (t=0.307, P=0.759) were slightly higher than baseline, the differences were not statistically significant. No serious adverse events occurred in any patient.  Conclusion  Sucroferric Oxyhydroxide effectively reduced serum phosphorus levels in MHD patients with inadequate phosphorus control, increased serum ferritin levels, and improved iron stores, with an overall favorable safety profile.