Objectives: The month of Ramadan is believed to induce significant dietary changes, raising concerns for hemodialysis (HD) patients, particularly in Muslim-majority countries. However, limited evidence exists describing dietary patterns and nutritional changes following Ramadan fasting among this population. This study aimed to identify specific dietary patterns during Ramadan and investigate their association with nutritional parameters. Methods: A multi-center prospective observational study enrolled 102 Muslim patients undergoing thrice-weekly HD sessions, planning to fast during Ramadan. Nutritional and functional status assessments were conducted two weeks before and at the fourth week of Ramadan. Parameters included anthropometry, biochemical data, clinical information, dietary intake, and handgrip strength. Dietary patterns (dp) were derived through principal component (PC) analysis and reduced rank regression (RRR). General Linear Model (GLM) was used to examine associations between nutritional parameters and specific dietary patterns. Results: Five dietary patterns emerged: 'Home Food' (PC-dp1), 'Meat Fat' (PC-dp2), 'Oily Rice & Noodle' (PC-dp3), 'Ramadan Traditional' (PC-dp4), and 'RRR-Ramadan Modern' (RRR-dp). The highest tertile (T3) of PC-dp1 was significantly (p < 0.01) associated with higher intakes of total protein, total potassium, and total fluid but lower phosphate:protein ratio. T3 of RRR-dp had significantly (p < 0.01) higher intakes of total carbohydrates, total fat, total phosphate, and phosphate:protein ratio, with greater increments in serum potassium and serum phosphate during Ramadan. Similarly, T3 of PC-dp2 observed a greater elevation of serum phosphate. Conclusions: Dietary patterns during Ramadan, characterized by the intake of processed meat, fast food, Ramadan finger food, and refined grains—resembling the Western dietary pattern—are associated with poor nutritional indicators. In contrast, a home-cooked diet with well-balanced food choices is associated with non-detrimental nutritional changes among this population.