Introduction At present, the use of mixed venous oxygen saturation (SvO2) is widely used as an index of tissue oxygen demand-supply balance in patients after cardiac surgery. However, it still remains challenging to identify patients with assumed adequate circulatory status quantified by SvO2 in chronic dialysis patients because of arteriovenous shunts for hemodialysis. Venous to arterial carbon dioxide difference (AVCO2) has been reported as a global marker of adequacy of tissue perfusion in sepsis patients. We sought to correlate AVCO2 with other variables for assessment of oxygen delivery (serum lactate, SvO2, serum hemoglobin, cardiac index); As well as investigate its capacity to predict poor outcome associated with low cardiac output syndrome (LCOS) in chronic dialysis patients after cardiac surgery. Methods A retrospective observational study was carried out in our intensive care unit from March 2013 to March 2017. Chronic dialysis patients who underwent cardiac surgery with cardiopulmonary bypass were enrolled in this study. On ICU admission, blood sample was obtained simultaneously from an arterial line and a central venous line. Poor outcome was defined as any: inotrope score >15, death, cardiac arrest, use of intra-aortic balloon pumping, unplanned surgical re-intervention. Results In total, 55 patients were included in this study. There was no strong correlation between AVCO2 and other commonly used variables including serum lactate (R = −0.04), SvO2 (R = −0.13), serum hemoglobin (R = −0.03) and cardiac index (R = −0.17). 11/55 patients (20%) had poor outcome. There was no difference in median AVCO2 (8.9(5.9-10.5) vs 7.2(5.4-9.0) mmHg, p = 0.35), serum lactate (17(11-23) vs 15(10-17) mg/dl, p = 0.34) and SvO2 (71(65-77) vs 75(70-80) %, p = 0.19) between patients with poor outcome and those without poor outcome on ICU admission. Mean arterial blood pressure on ICU admission was significantly lower in patients with poor outcome than those without poor outcome (63(60-69) vs 74(68-80) mmHg, p = 0.004). Operation time was significantly longer in patients with poor outcome than those without poor outcome (517(413-570) vs 391(317-447) minutes, p = 0.009). Discussion AVCO2 was not correlated with important variables for assessment of oxygen delivery and, does not appear to be associated with poor outcome related LCOS in chronic dialysis patients after cardiac surgery. Serum Lactate and SvO2 are also not associated with poor outcome in this population. Mean arterial blood pressure on ICU admission and operation time are associated with poor outcome. Further study is needed to identify other predictive value of outcome in chronic dialysis patients after cardiac surgery.