Background/Aims: Visual impairment often limits people`s ability to perform daily tasks and affects their quality of life. The association between visual impairment and mortality has been controversial. Moreover, literature on the relationship was very limited in the hemodialysis (HD) patients. We evaluated the impact of visual impairment on clinical outcomes in HD patients. Methods: A total of 3,250 HD patients included from the Clinical Research Center Registry for end stage renal disease (ESRD) in Korea. Visual acuity was assessed by the questionnaire for visual acuity. Patients with visual impairment were operationally defined as patients who have difficulty in usual life due to decrease in visual acuity or patients with blindness. The primary outcome measure was all-cause mortality and secondary outcome was first hospitalization. Results: The median follow-up period was 30 months. Kaplan-Meier analysis showed that the all-cause mortality rate and first-hospitalization rate significantly increased in patients with visual impairment (p<0.001 and p<0.001, Log-rank, respectively). In the multivariate Cox regression analyses, patients with visual impairment had significantly higher all-cause mortality rate and first-hospitalization rate compared with patients with normal visual acuity (HR 1.39, 95% CI, 1.05-1.84, p=0.020 and HR 1.30, 95% CI, 1.14-1.48, p<0.001, respectively). Conclusions: Our data demonstrated that visual impairment was strongly associated with all-cause mortality and hospitalization in HD patients.