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PURPOSE. We evaluated the effect of hemodialysis on the choroidal thickness in patients with and without diabetes who have end-stage kidney disease (ESKD). METHODS. Forty-one patients with ESKD were recruited and divided into two groups: those with ESKD due to diabetic nephropathy (DM group, 37 eyes of 20 patients) and those with nondiabetic ESKD (NDM group, 40 eyes of 21 patients). Using spectral-domain optical coherence tomography (SD-OCT), the subfoveal choroidal thickness (SCT) was measured before and after hemodialysis, and the change ratio (DSCT [%]) was calculated. RESULTS. The SCT decreased in all eyes after hemodialysis. The DSCT value in the DM group (� 12.6 6 2.7%) was significantly (P ¼ 0.00027) larger than that in the NDM group (� 6.9 6 2.3%). Moreover, the DSCT per body fluid removal (BFR [L]) in the DM group was significantly (P ¼ 0.013) greater than in the NDM group. In the DM group, the mean DSCT in the eyes treated with panretinal photocoagulation (PRP; n ¼ 19) was significantly (P ¼ 0.035) larger than that in eyes not treated with PRP (n ¼ 18). The relationship between the DSCT and BFR was not significant (R 2 ¼ 0.0038, P ¼ 0.80) in the DM group but was significant (R 2 ¼ 0.54, P ¼ 0.00013) in the NDM group. CONCLUSIONS. The current results may reflect that systemic fluid accumulation has a greater effect on the diabetic choroid, probably due to damage to the choroidal vasculature, in patients with ESKD.