Cardiac surgery in dialysis-dependent patients with renal failure is a serious and challenging problem for both the patient and the cardiac surgeon. Patients with severe renal failure are at high risk for cardiac surgery, with risk factors including diffuse coronary atherosclerosis, aortic calcification, and impaired postoperative water-electrolyte balance and postoperative bleeding, which is further increased by the use of extracorporeal circulation. From September 2004 to February 2012, a total of 18 patients with end-stage renal disease dependent on hemodialysis or peritoneal dialysis were admitted to our department for cardiac surgery. Thirteen patients underwent coronary artery bypass graft (CABG) alone; three underwent valve replacement alone, and two underwent a combination of CABG and valve replacement (VR). The three patients underwent simple valve replacement surgery and two had a combination of CABG and valve replacement (VR) surgery. As a result, 3 patients died in the perioperative period and 15 patients were discharged successfully. The postoperative follow-up ranged from 6 to 91 months (27.6±27.5 months), 2 patients died (66 and 76 months postoperatively), 3 patients had nonfatal complications, and the surviving patients were in good cardiac functional status with New York heart association (NYHA) cardiac function class I in 4 cases and class II in 9 cases. Conclusion: Although dialysis-dependent patients with end-stage renal disease are a high-risk group for cardiac surgery, a comprehensive perioperative management of water-electrolyte-acid-base balance and coagulation can lead to a better prognosis for patients.