The impact of stroke and acute myocardial infarction (AMI) on the incidence of end-stage renal disease (ESRD) is unknown. Two community-based registries, one of patients with stroke or AMI and another of patients with ESRD who undergo dialysis, are available in Okinawa, Japan. Whether survivors after stroke and AMI who were registered from April 1988 through March 1991 entered an ESRD dialysis program by the end of December 1999 was determined. Among 4,556 patients (3,809 patients with stroke, 747 patients with AMI) who survived at least 28 days after the event onset, 44 patients (36 patients, stroke; 8 patients, AMI) entered an ESRD dialysis program during the study period. The 10-year cumulative incidence of ESRD was approximately 2.0% in those who survived stroke or AMI. The observed-expected ratio was 4.1 in men (P < 0.01) and 5.8 in women (P < 0.01) aged 30 to 59 years and 0.8 in men (not significant) and 0.4 in women (not significant) 60 years and older. The present results confirm that survivors after stroke or AMI have a greater incidence of ESRD than those in the general population, in particular, those who had stroke or AMI at 60 years or younger.