There is limited knowledge on the prevalence and risk factors of diabetic retinopathy (DR) in dialysis patients. We have investigated the association between diabetes mellitus and lipid-related biomarkers and retinopathy in hemodialysis patients. We reviewed 1,255 hemodialysis patients with type 2 diabetes mellitus (T2DM) who participated in the German Diabetes and Dialysis Study (4D Study). Associations between categorical clinical, biochemical variables and diabetic retinopathy were examined by logistic regression. On average, patients were 66 ± 8 years of age, 54% were male and the HbA1c was 6.7% ± 1.3%. DR, found in 71% of the patients, was significantly and positively associated with fasting glucose, HbA1c, time on dialysis, age, systolic blood pressure, body mass index and the prevalence of other microvascular diseases (e.g. neuropathy). Unexpectedly, DR was associated with high HDL cholesterol and high apolipoproteins AI and AII. Patients with coronary artery disease were less likely to have DR. DR was not associated with gender, smoking, diastolic blood pressure, VLDL cholesterol, triglycerides, and LDL cholesterol. In summary, the prevalence of DR in patients with type 2 diabetes mellitus requiring hemodialysis is higher than in patients suffering from T2DM, who do not receive hemodialysis. DR was positively related to systolic blood pressure (BP), glucometabolic control, and, paradoxically, HDL cholesterol. This data suggests that glucose and blood pressure control may delay the development of DR in patients with diabetes mellitus on dialysis. Diabetes mellitus (DM) is more common in Western countries. The chronic course of DM and multiple endorgan damages like diabetic nephropathy, neuropathy, and retinopathy (DR) compromises the quality of life of affected patients and produces increased health care costs 1. Type 2 diabetes mellitus (T2DM) is the most common single disease causing end-stage renal disease (ESRD) which results in hemodialysis. Diabetic nephropathy has been reported in approximately 40% of patients who need renal replacement therapy 2. Patients with T2DM on hemodialysis show a higher prevalence of co-morbidities and poorer outcome in comparison to non-diabetic patients on dialysis 3. This is reflected by a five-year survival rate of only 35% 4. DR is a common result of DM. The prevalence rate of DR in T2DM-patients not receiving dialysis varies within a broad range: it is reported between 34.6 5 and 64% 6. DR is one of the main reasons for blindness in the Western hemisphere. Global causes of visual impairment and blindness are 1% due to diabetic retinopathy 7. The annual incidence rate of blindness due to DR is between 1.2 and 2.1 per 100.000 8. The life expectancy of T2DM patients on dialysis has recently improved due to technical enhancements, e.g. refined control of the dialysis-machines, high-flux and bio-compatible membranes, more flexible catheters and pre-mounted stents with lower profile 9,10. Therefore, quality of life in these patients becomes more critical. Although DR is not...