Introduction: There have been few studies on the treatment of acute cholecystitis (AC) in hemodialysis (HD) patients. The aim of this study was to investigate the risk factors for mortality in HD patients who developed AC, and to compare the results of treatment. Materials and Methods: The records of HD patients who developed AC between 2009 and 2019 were analyzed retrospectively. The diagnosis and severity of AC was made according to Tokyo Guideline (TG) 18. The American Society of Anesthesiologists (ASA) scores were used for surgical risk. The Charlson comorbidity index (CCI) was used for comorbid conditions of patients. Risk factors were investigated for mortality. Medical treatment and cholecystectomy results were compared. Results: Thirty-four patients were included in the study. Mortality occurred in six patients (17.6%). Age ≥65 years, an ASA IV score, a CCI ≥8, Tokyo Guideline 18 (TG 18) grade III, and blood urea nitrogen ≥60 mg/dL were increased those who died (p=0.03, p=0.001, p=0.02, p<0.001, p=0.03; respectively). According to TG 18, there was no difference between the medical treatment and cholecystectomy groups in terms of clinical success, readmission, and mortality rates (p=1.00, p=0.64, p=1.00; respectively). However, length of hospital stay was longer in the cholecystectomy group (p=0.01). Conclusion: Despite the suggestions in the TG 18, medical treatment and in-hospital early cholecystectomy can be performed with similar clinical success, readmission, and mortality rates in HD patients who develop AC