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Background/Objectives: Renal failure severe enough to require dialysis (ESRD) complicates multiple myeloma (MM) in up to 10% of hospitalizations. This study examined disparities in hospitalization and outcomes among MM and ESRD patients according to sex and race Methods: From the nationwide inpatient sample database, we analyzed 4,615 adult hospitalizations for patients with MM and ESRD between January 1, 2016, and December 31, 2020. Baseline sex and race characteristics were analyzed using chi-square tests and Student's t-test. Hierarchical multivariable logistic regression analysis evaluated the odds of primary and secondary outcomes. All patient refined-diagnosis-related groups (APR-DRG) metrics and the Charlson comorbidity index (CCI) metrics were used to adjust illness severity, baseline risk of mortality, and comorbidity burden. Prolonged hospitalization was defined as the length of hospital stay in the top decile (23 days). Results: Women with MM and ESRD were significantly older (65.5 vs. 58.1 years; P = 0.045) and had a higher prevalence of COPD (17.5 vs. 12.1%; P = 0.022), lymphopenia (14.1% vs. 6.9%; P 0.001), osteoporosis (4% vs. 0.5%; P 0.001), and electrolyte abnormalities (1.7% vs. 0.4; P = 0.014), whereas men had higher prevalence of tobacco use (35.2% vs. 22.6%; P < 0.001), coronary artery disease (163.5% vs. 10.2%; P = 0.008), and previous PCI (4.6% vs. 1.4%; P = 0.010). Compared with nonwhite patients, White Americans were older (67.3 vs. 63.6; P < 0.001) and had a higher prevalence of obesity (6.7% vs. 3.8%; P = 0.047), diabetes (37.3% vs. 24.3%; P < 0.001), and electrolyte abnormalities (2.3% vs. 1%; P = 0.032). A higher prevalence of COPD (17.6% vs. 11%; P = 0.004) was observed in nonwhite patients. Compared with female sex, male sex was significantly correlated with greater odds of mortality (11.6% vs. 9.7%; aOR: 1.32; 95% CI: 1.03-2.08; P = 0.030), bone marrow transplantation (25.0% vs. 22.3%; aOR: 1.15; 95% CI: 1.03-1.58; P = 0.037), and any MACE (3.9% vs. 2.1%; aOR: 3.9; 95% CI: 1.12-1.0; 1.06-2.29; P=0.028). Female sex was correlated with greater odds of VTE (11.3% vs. 7.6%; aOR: 1.59; 95% CI: 1.17-2.61; P = 0.039), depression (1.4% vs. 0.5%; aOR: 1.08; 95% CI: 1.04-1.22; P = 0.028), and prolonged hospitalization (15.5% vs. 13.1%; aOR: 1.24; 95% CI: 1.14-2.66; P = 0.027). White race was correlated with a greater likelihood of ASCT (10.6%; aOR: 1.15; 95% CI: 1.08-1.93; P = 0.026) and depression (1.4%; aOR: 1.08; 95% CI: 1.04-1.32; P = 0.028). Black race was correlated with greater odds of VTE (12.1%; aOR: 1.35; 95% CI: 1.24-1.93; P = 0.048) and any MACE (2.8%; aOR: 1.32; 95% CI: 1.07-3.27; P = 0.035) and lower odds of ASCT (5.4%; aOR: 0.45; 95% CI: 0.27-0.76; P = 0.003). Hispanic and Asian/Pacific Islander descent were associated with significantly higher mortality (12.1%, P = 0.015 and 12.2%, P = 0.002, respectively) and greater likelihood of major transfusion (36.4%, P = 0.029 and 30.3%, P = 0.049, respectively). Asian/Pacific Islander descent was also correlated with greater odds of ARF (39.4%; aOR: 1.61; 95% CI: 1.34-2.46; P = 0.016). Native American descent was correlated with a greater risk of VTE (8.9%; aOR: 4.14; 95% CI: 0.90-8.97; P = 0.068). No significant differences in mean hospital stay and hospital cost were observed by race and sex among patients with MM and ESRD. Conclusion: Male patients exhibited higher odds of mortality, bone marrow transplantation, and major adverse cardiovascular events, whereas female patients exhibited greater odds of venous thromboembolism, depression, and prolonged hospital stays. Racial disparities were also evident; white patients were more likely to receive autologous stem cell transplantation and report depression, whereas nonwhite patients, especially those of Black, Hispanic, Asian/Pacific Islander descent, had higher risk of venous thromboembolism, major adverse cardiovascular events, and mortality.