Objective  To explore the risk factors and prognosis of intracerebral hemorrhage (ICH)  in dialysis dependent end stage renal disease (ESRD) patients.  Methods  We retrospectively analyzed ESRD patients receiving regular maintenance dialysis at Beijing Shunyi District Hospital (January 2021-January 2024). Participants were stratified into ICH and non-ICH groups. Demographic characteristics, medical history, laboratory parameters, imaging findings, and treatment data were compared to identify ICH risk factors.  Results  Among 206 enrolled patients, 42 (20.4%) developed ICH. Compared to non-ICH controls (n=164), the ICH group showed significantly higher proportions of males χ²=4.323, P=0.016), stroke history (χ²=7.621, P=0.000), hemodialysis (vs. peritoneal dialysis; χ²=0.294, P=0.043), elevated mean pre-dialysis systolic blood pressure (SBP) within 3 months (Z=3.532, P=0.030), antiplatelet drug use (χ²=4.021, P=0.026), white matter hyperintensity (χ²=6.202, P=0.002), and cerebral microhemorrhage (χ²=9.282, P＜0.000), along with elevated B-type natriuretic peptide (t=4.326, P=0.024), fibrinogen (t=3.002, P=0.038), serum calcium (t=4.234, P=0.023), and  phosphorus (t=5.203, P=0.006) levels, but decreased platelet count (t=3.469, P=0.032) and serum sodium (t=9.821, P＜0.000) levels. Multivariate Logistic regression analysis identified independent ICH risk factors: stroke history (OR=1.610, 95% CI:1.021～4.320, P=0.041), elevated mean pre-dialysis SBP within 3 months (OR=2.526, 95% CI:1.470～5.323, P=0.004), hemodialysis (OR=3.190, 95% CI: 1.620～6.270, P=0.007), white matter hyperintensity (OR=3.521,95% CI:1.313～6.482, P=0.030), and cerebral microhemorrhage (OR=2.797,95% CI:1.168～6.701, P=0.011). At 3-month follow-up,  31.0% (13/42) of ICH patients had favorable outcomes (modified Rankin scale, mRS ≤2)；while 69.0% (29/42) had poor outcomes (mRS>2), including 4 deaths (9.5%).   Conclusion  ESRD patients face elevated ICH risk with relatively poor prognosis in this population.