Valorization of River Sediments in Sustainable Cementitious Gel Materials: A Review of Characteristics, Activation, and Performance

River sediments have attracted increasing attention as alternative raw materials for sustainable cementitious materials due to their abundant availability and silica–alumina-rich composition. In this study, a systematic literature search was conducted in Web of Science and Google Scholar using combinations of the keywords “river sediment,” “cementitious materials,” “activation,” and “pozzolanic activity,” covering publications up to July 2025. In addition, a citation network tool (Connected Papers) was employed to trace related works and ensure comprehensive coverage of emerging studies. This review systematically examines the properties of river sediments from diverse regions, along with activation and modification techniques such as alkali/acid activation, thermal calcination, and mechanical milling. Their applications in various cementitious systems are analyzed, with mix design models compared to elucidate the effects of replacing fine aggregates, coarse aggregates, and cement on workability, strength, and durability. Multi-scale characterization via XRD, FTIR, and TG-DSC reveals the mechanisms of C–S–H and C–A–S–H gel formation, pore refinement, and interfacial transition zone densification. The review highlights three key findings: (1) moderate sediment replacement (20–30%) improves strength without compromising flowability; (2) alkali–water glass activation and calcination at 600–850 °C effectively enhance pozzolanic activity; and (3) combining the minimum paste thickness theory with additives such as water reducers, fibers, or biochar enables high-performance and low-carbon concrete design. This review provides a comprehensive theoretical foundation and technical pathway for the high-value utilization of river sediments, carbon reduction in concrete, and sustainable resource recycling.