PURPOSE: Patients on hemodialysis (HD) undergoing coronary artery bypass grafting (CABG) face a high risk of perioperative complications, and the optimal timing of perioperative HD remains unclear. We evaluated the safety and feasibility of a standardized HD protocol in patients undergoing off-pump CABG (OPCAB). METHODS: We retrospectively analyzed 64 HD-dependent patients who underwent elective OPCAB at a single institution between March 2014 and December 2024. The protocol included maintaining a Monday-Wednesday-Friday HD schedule, performing routine HD on Monday morning, conducting OPCAB on Monday afternoon, and resuming HD on postoperative day (POD) 2. Clinical outcomes, unplanned dialysis, and perioperative biochemical changes were assessed. RESULTS: Seven patients (10.9%) required unplanned renal replacement therapy before the first postoperative HD session for congestive heart failure (n = 3), hyperkalemia (n = 3), or respiratory failure (n = 1). None required additional dialysis after the initial postoperative HD. In-hospital mortality was 3.1%. Postoperative congestive heart failure occurred in 4.7% of patients. Body weight returned to near baseline by POD 7, and serum potassium remained within an acceptable range throughout the perioperative period. CONCLUSION: This standardized perioperative HD protocol was feasible for maintenance HD patients undergoing elective OPCAB. However, protocol deviation in 10.9% of patients suggests that further refinement and prospective comparative studies are warranted.