The new-generation acetylcholinesterase inhibitor, donepezil, is useful in the treatment of mild-to-moderate Alzheimer’s disease. A 72-year-old male chronic hemodialysis patient was diagnosed as having moderate Alzheimer’s disease. We administered donepezil at 3 mg/day orally to the patient. After 1 month’s treatment, the patient improved to a controllable psychiatric condition and was discharged from the hospital. The 24-hour plasma concentration profile of donepezil following the 3-mg once-daily dose varied from 11.1 to 18.2 ng/ml. The through level of donepezil was reduced from 12.4 to 10.9 ng/ml over a 3-month period. We did not experience any episodes of drug toxicity or adverse effects in this chronic dialysis patient. Donepezil treatment might have a beneficial impact on patients with severe renal dysfunction.