Background:  In patients with chronic renal failure undergoing haemodialysis (HD), silent cerebral infarctions (SCI) are associated with high mortality. Levels of monocyte chemoattractant protein‐1 (MCP‐1) increase with renal dysfunction and may be a novel predictor for cerebrovascular events. We tested the hypothesis that increased MCP‐1 concentration correlate with the occurrence of SCI in HD patients. Methods:  Using cranial magnetic resonance imaging (MRI) findings, 52 Japanese patients undergoing HD were divided into two groups: with SCI (61 ± 7 years, mean ± SD, n= 28) and without SCI (60 ± 6 years, n= 24). The gender, metabolic profiles and MCP‐1 concentration were compared between the two groups. Results:  The level of MCP‐1 was higher in the with‐SCI group than in the without‐SCI group (P < 0.0001). The proportion of smokers was higher in the with‐SCI group (P < 0.05) than in the without‐SCI group. Plasma level of high‐density lipoprotein cholesterol was lower, while uric acid level was higher, in the with‐SCI group (P < 0.05 and P < 0.05 respectively) compared to the without‐SCI group. Multiple logistic regression analysis identified MCP‐1 level as being significantly associated with the presence of SCI (odds ratio 1.48, 95% confidence interval = 1.10–5.75, P < 0.0001). Conclusions:  This study indicates that patients with chronic renal failure who are maintained on HD exhibit an increased prevalence of SCI, and that MCP‐1 is significantly associated with the presence of SCI in HD patients.