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Introduction End-stage renal disease (ESRD) is a major risk factor for cardiovascular morbidity and mortality. While ESRD traditionally affects older adults, younger individuals are increasingly developing kidney failure due to rising rates of diabetes and hypertension. ESRD’s impact on outcomes in patients with non-revascularized ST-elevation myocardial infarction (STEMI) complicated by cardiogenic shock(CS) remains poorly defined, particularly among younger adults.Methods Using data from the Nationwide Readmissions Database (NRD) from 2016–2022, adult patients aged ≥18 and ≤59 years admitted with non-revascularized STEMI complicated by CS were stratified by ESRD status; patients with chronic kidney disease were excluded. In-hospital outcomes and 30-day readmission rates were assessed using multivariable logistic regression and Cox proportional hazards models respectively.Results Of 8,143 patients, 893 (10.96%) had ESRD. ESRD patients were more likely to be female (39.0% vs 30.3%, p=0.0002) and use Medicare (64.0% vs 15.7%, p<0.0001), with greater comorbidity burden including congestive heart failure (84.5% vs 68.0%), valvular disease (23.4% vs 13.1%), peripheral vascular disease (16.5% vs 11.7%), dyslipidemia (48.1% vs 37.4%), diabetes (69.0% vs 33.9%), prior stroke (6.4% vs 4.1%), prior myocardial infarction (17.6% vs 10.7%), hypertension (91.8% vs 57.7%), obstructive sleep apnea (11.5% vs 6.2%), and coagulopathy (26.5% vs 19.8%), but lower smoking (24.0% vs 47.8%) and chronic obstructive pulmonary disease (11.4% vs 15.4%) (all p<0.05). ESRD patients had higher Charlson index (5.9 vs 2.8), longer stay (12.6 vs 8.7 days), and higher charges ($327,619 vs $245,934) (all p< 0.05). After adjustment, ESRD was associated with higher odds of mortality (aOR:1.526, 95%CI:1.195-1.947, p=0.0007), acute kidney injury requiring hemodialysis (aOR:2.413, 95%CI:1.730-3.367, p<0.0001), cardiopulmonary resuscitation (aOR:1.706, 95%CI:1.320-2.196, p<0.0001), and intubation (aOR:1.317, 95%CI:1.051-1.649, p=0.017), but lower odds of intra-aortic balloon pump use (aOR:0.610, 95%CI:0.445-0.835, p=0.002) and ventricular tachycardia (aOR:0.728, 95%CI:0.556-0.952, p=0.021). No differences were found for extracorporeal membrane oxygenation (aOR:0.686, p=0.192), Impella (aOR:0.737, p=0.118), left ventricular assist device (aOR:1.554, p=0.320), vasopressors (aOR:0.986, p=0.920), or supraventricular tachycardia (aOR:1.205, p=0.482). Among survivors, 31.36% of ESRD patients versus 17.8% of non-ESRD patients were readmitted within 30 days (adjusted HR:1.412, 95%CI:1.069-1.866, p=0.015).Conclusion In young adults with non-revascularized STEMI complicated by cardiogenic shock, ESRD is associated with a higher burden of comorbidities, longer hospital stays, increased risk of in-hospital complications, and significantly higher 30-day readmission rates, highlighting the need for targeted management strategies in this high-risk population.