BACKGROUND: Chronic kidney failure is a global public health challenge and is associated with a higher risk of intracerebral hemorrhage (ICH). ICH is known to result in a poorer prognosis in hemodialysis (HD) patients than in non-HD patients. METHODS: This retrospective study examined 445 consecutive cases of ICH to investigate the disparities in outcomes between HD (44 cases) and non-HD (401 cases) patients. The 2 groups were compared based on demographic and clinical factors, and multivariate analyses were performed to identify risk factors for adverse outcomes. RESULTS: The HD group showed a significantly younger age (68.1 vs. 72.9, P = 0.01) and higher frequencies of hypertension, diabetes, anticoagulant use, a history of smoking, and a history of stroke. Clinical outcomes were worse in the HD group (P <
0.01). Detailed analysis of ICH characteristics revealed a higher rate of hematoma enlargement in the HD group (P <
0.01). Multivariate analysis confirmed dialysis and anticoagulant use as significant risk factors for hematoma enlargement. CONCLUSIONS: The study concludes that HD patients with ICH exhibit a higher risk of hematoma enlargement and poorer clinical outcomes. Dialysis and anticoagulant use emerged as significant risk factors for hematoma enlargement. Larger prospective studies are essential for validating these findings.