Nonarteritic anterior ischemic optic neuropathy (NAION) is a rare complication in chronic hemodialysis patients. NAION is an associated with many systemic processes, including intradialytic hypotension, anemia, and accumulations of toxin such as urea. A 65-year-old female with end-stage kidney disease presented right, painless vision loss following treatment with hemodialysis at 1 month ago. Fundoscopy revealed severe right chalky-white opticdisc edema. Visual field examination showed a superior altitudinal defect in right eye. Her intradialytic blood pressure was significantly lower than her baseline and severe fluctuated. Treatments of NAION are not established and focus on optimizing the modifiable risk factors to prevent further complications. Her intradialytic blood pressure was stabilized and her dialysis sessions were changed. At the 1-year follow-up, the opticdisc edema slightly resolved and her vision improved slightly. Intradialytic blood pressure must be closed monitored and dialysis protocol must be optimized to prevent the NAION.