Dialysis anemia is one of the severe complications in chronic hemodialysis patients. A high-aluminum dialysate causes microcytic hypochromic anemia in hemodialysis patients by aluminum intoxication. We have treated 61 chronic hemodialysis patients using a low-aluminum dialysate for 5 years. We did not find microcytic hypochromic anemia in any of our patients, and we also found no relationship between serum aluminum concentration and hematological examination such as red blood cell count, hemoglobin and serum iron. A low aluminum dialysate is necessary for the prevention of microcytic hypochromic anemia in hemodialysis patients.