Objective To gain an in-depth understanding of the lived experiences of self-management of hyperphosphatemia in maintenance hemodialysis patients, and to provide reference for clinical nursing practice. Methods Semi-structured interviews were conducted with 13 maintenance hemodialysis patients experiencing hyperphosphatemia. Data were analyzed and coded using content analysis. Results Three main themes and twelve subthemes emerged:psychological and physical distress (itch, powerlessness, self-perceived burden, and illness uncertainty); decision dilemmas (challenges in phosphorus management, desire for life control, desire for control of phosphorus levels, and management strategies based on self-perception); and behavior change (cognition accumulation and transformation, active self-monitoring, mobilization of family resources, and seeking medical or peer support). Conclusion The self-management experience of patients with hyperphosphatemia on maintenance hemodialysis is complex. Nursing staff should provide targeted interventions to meet their demands，and assist patients to maintain phosphorus levels within the normal range.