With the aid of a computerized medical record search using the International Classification of Diseases, Ninth Revision (ICD-9)17 discharge codes, we identified 26 consecutive patients receiving maintenance hemodialysis who had a discharge diagnosis of stroke at our institution over a 10-year period (January 1987 to December 1996). Two patients were admitted to other hospitals for their stroke and it is from there that we obtained their data. Maintenance hemodialysis was defined as a requirement for supportive dialysis therapy for at least 30 days and continuation of dialysis in the outpatient setting in accordance with the definition of the Health Care Financing Administration.12 Patients received dialysis using single-pass machines with cellulose acetate–hollow fiber dialyzers and standard tubing. There was no dialyzer reuse. Patients underwent dialysis 3 times weekly using bicarbonate or acetate-based dialysate solutions of standard composition. All dialysis machines were cleaned between treatments using standard methods. After human recombinant erythropoietin became generally available in 1989, the majority of our patients were treated with this agent. Clinical data, including age, race, sex, and the presence of diabetes mellitus, hypertension, coronary artery disease, congestive heart failure, left ventricular hypertrophy, cardiac dysrhythmia, and peripheral vascular disease, were recorded. All computed tomographic and/or magnetic resonance imaging scans of the brain, including follow-up examinations, were interpreted by an attending neuroradiologist. Existence of coronary artery disease was defined by 1 or more of the following criteria: prior myocardial infarction or angina, abnormal results on thallium stress testing, and/or documentation by cardiac catheterization. Congestive heart failure was considered to be present if patients had a clinical history consistent with congestive heart failure and/or if there was evidence of congestive heart failure on chest radiographs, echocardiograms, or nuclear ejection fraction studies. Left ventricular hypertrophy was diagnosed using standard electrocardiographic and/or echocardiographic criteria. A history of cardiac dysrhythmia was determined by review of patients' medical records, including Holter monitor reports or cardiac rhythm recordings during prior hospitalizations. Peripheral vascular disease was considered present if there was a history of claudication, arterial bypass, gangrene, amputation, and/or abnormal findings of duplex or arteriographic studies. Blood pressure and laboratory data obtained before dialysis during the month prior to the stroke were recorded. Duration of stay in the hospital, disposition (discharge home [defined as a good outcome] or discharge to a nursing facility or death [defined as a poor outcome]), and the presence of a residual neurological deficit at the time of discharge were all recorded. A control group of 87 consecutive cases of stroke in hospitalized patients at our institution with normal renal function (defined as a serum creatinine level ≤124 mmol/L [1.4 mg/dL]) were examined as well.