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Summary Introduction Laparoscopic cholecystectomy (LC) is widely accepted as the standard treatment for acute cholecystitis. Emergency LC is associated with significantly high morbidity and mortality rates in high-risk patients, including those who are critically ill, those who are elderly, end-stage renal disease (ESRD) patients, and those with septicemia. Purpose To evaluate the safety and outcomes of emergency LC in ESRD patients on maintenance hemodialysis. Methods Between January 2006 and December 2011, the medical records of 22 ESRD patients with acute calculous cholecystitis who were undergoing maintenance hemodialysis and had received emergency LC were reviewed retrospectively. Results The patients were 10 men and 12 women with a mean age of 69.3 years. Emergency LC was successfully performed on 20 patients, and two patients converted to open cholecystectomy. The conversion rate was 9% and the mean hospital stay was 4.8 (range 3–8) days. Wound infection occurred in two patients and common bile duct injury in one; no other complications and no perioperative mortality occurred in this study. Conclusion Emergency LC can be performed safely in ESRD patients undergoing maintenance hemodialysis. The duration of hospital stay, outcomes, and surgical conversion rate of patients undergoing this procedure are similar to those of the general population not undergoing emergency LC.