The risk of ischemic stroke is particularly high in dialysis patients of any age. Patients on dialysis are also associated with severe neurologic deficits and poor functional outcome after stroke presentation. This may be due to cerebrorenal interactions such as chronic inflammation, oxidative stress, sympathetic overactivity, prothrombotic conditions, and uremia related factors, as well as higher frequency of traditional risk factors. For stroke prevention or improving the functional outcome after stroke in patients on dialysis, more appropriate treatment strategy would be required. However, end-stage renal disease limits the use of pharmacotherapy, endovascular treatment, and risk factor controls because of safety issues. Accordingly, many dialysis patients were less likely to receive important guideline-recommended therapies in practice. Many issues about the safety and efficacy of many therapeutic options still remain uncertainty in this population because patients on dialysis have been under-represented in the cardiovascular trials. Therefore, appropriately designed randomized clinical trials are required in the future to determine the appropriate therapeutic strategy in patients on dialysis.