Background There is a paucity of contemporary data on the characteristics and outcomes of acute ischemic stroke ( AIS ) in patients on maintenance dialysis. Methods and Results We used the nationwide inpatient sample to examine contemporary trends in the incidence, management patterns, and outcomes of AIS in dialysis patients. A total of 930 010 patients were admitted with AIS between 2003 and 2014, of whom 13 642 (1.5%) were on dialysis. Overall, the incidence of AIS among dialysis patients decreased significantly ( P trend P trend =0.78). Compared with non‐dialysis patients, those on dialysis were younger (67±13 years versus 71±15 years, P AIS compared with 16.7% of patients in the non‐dialysis group ( P P P trend Conclusions Dialysis patients have 8‐folds higher incidence of AIS compared withnon‐dialysis patients. They also have higher risk‐adjusted in‐hospital mortality, sepsis and blood transfusion, longer hospitalizations, and higher cost. There is a need to identify preventative strategies to reduce the risk of AIS in the dialysis population.