Introduction: We aim to determine the influence of lower gastrointestinal bleeding (LGIB) on mortality, morbidity, length of hospital stay, and resource utilization in end-stage renal disease (ESRD) patients. Material and Methods: The National Inpatient Sample database (2016 &2017) was used for data analysis using the International Classification of Diseases, Tenth Revision codes to identify the patients with the principal diagnosis of ESRD and LGIB. We assessed the all-cause in-hospital mortality, morbidity, predictors of mortality, length of hospital stay (LOS), and total costs between propensity-matched groups of ESRD patients with LGIB versus ESRD patients. Results: We identified 2187954 ESRD patients, of whom 242075 has LGIB, and 1945879 were ESRD patients. The in-hospital mortality was higher in ESRD with LGIB (OR 2.5, 95% CI 1.5-2.2; P=0.00). ESRD with LGIB has higher odds of mechanical ventilation (OR 1.4, 95% CI 6.4-16.4; P=0.00), and shock requiring vasopressor (OR 1.2, 95% CI 4.9-5.4; P=0.002). Advanced age (OR 1.02 CI 1.02-1.03 P=0.00), anemia (OR 1.04 CI 1.59-1.91 P=0.006), acute coronary syndrome (OR 1.8 CI 1.6-2.1, P=0.00), acute respiratory failure (OR 1.29 CI 2.0-2.6, P=0.00), mechanical ventilation (OR 1.9, CI 3.5-4.4, P=0.00), and sepsis (OR 1.5, CI 4.1-5.08, P=0.00) were identified as predictors of mortality in ESRD with LGIB. Mean LOS (10.8±14.9 vs. 6.3±8.5, P<0.01) and mean total charges (37054 $ vs. 18080 $, P<0.01) were also higher. Conclusions: In this propensity-matched analysis, ESRD with LGIB was associated with higher odds of in-hospital mortality, mechanical ventilation, and shock requiring vasopressor. Mean LOS and resource utilization were also higher.