Introduction: This study aimed to assess the association between visual acuity (VA) and contrast sensitivity (CS) in patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD), stratified by diabetes mellitus (DM) status. Methods: A cross-sectional study with a total of 100 HD patients was enrolled. Based on their HbA1c levels, they were categorized as having DM or as normal. They received a thorough eye examination, and those with corneal disease, cataracts, and macular disease were excluded. Best-corrected VA (BCVA) was evaluated using the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, and CS was assessed using the MARS numeral CS chart. Fisher’s exact test was employed to compare VA and CS based on DM status. Results: We analyzed 100 patients (185 eyes), consisting of 51 (51%) males and 49 (49%) females. The mean age of the study group was 47±12.8 (15-76) years. The BCVA in DM and non-DM was mostly in the 0.50-0.00 LogMAR category. CS values in DM and non-DM were mostly in >1.52 LogCS category. VA and CS were significantly different in both DM and non-DM groups (p=0.03; p=0.00, respectively). A strong correlation between VA and CS was also observed in both groups (r=0.644; r=0.573, respectively). Conclusion: Visual acuity and CS in ESRD patients with DM undergoing HD had significant differences from those without DM. BCVA was strongly correlated with CS in both groups. Monitoring VA and CS in HD patients with DM provides early detection of vision-threatening changes, helps prevent severe visual impairment and improves patients’ quality of life.