Percutaneous coronary intervention for patients with Coronary Heart Disease (CHD) accompanying End-Stage Renal Disease (ESRD) on hemodialysis therapy is complicated due to the presence of complex lesions and the associated severity of complications and high mortality rates. This study aimed to investigate the efficacy and safety and to simultaneously delineate optimal procedural algorithms and therapeutic strategies of PCI as the preferred revascularization approach in a limited population. A total of 18 patients with CHD accompanying ESRD on dialysis therapy who underwent PCI were analysed retrospectively. The procedural flowchart before and after PCI was described. The instant procedural success rate and peri- and post-procedural complications were analysed. Out-hospital follow-up data were also recorded. Twenty-eight PCI procedures were successfully performed in the 18 patients. The average number of stents was 2.2 ± 1.6 (1-6) per procedure, all of which were drug-eluting stents. Moderate to severe calcification in the coronary artery was found in 15 patients (83.3%), and rotational atherectomy was performed in four patients. The median follow-up duration was 18.9 (4-34) months. The degree of angina pectoris reduced in all patients, with no recurrence in 10 patients; the degree of angina pectoris reduced by one to two scales in eight patients after PCI. In-stent restenosis occurred in four patients (22.2%). One patient died after the fourth PCI procedure. PCI can be performed safely with high success rates in carefully selected patients with CHD accompanying ESRD on dialysis therapy and the symptoms would be alleviated effectively after optimizing procedural algorithms and therapeutic strategies.