Background. Rhubarb-containing Traditional Chinese Medicine (TCM) is widely used to manage chronic renal failure in China. Studies show that anthranoids contained in rhubarb are related to the occurrence of melanosis coli (MC). However, no study on the detection rate of MC in end-stage renal disease (ESRD) patients in China has been reported.Methods. We conducted a retrospective study on 99 ESRD patients who received a colonoscopy as part of pre-transplant work-up between Jan 1, 2017 and July 1, 2020 in a single center in Beijing, China. 200 age- and gender-matched subjects with normal renal function and received a colonoscopy for health screening in the same period were randomly selected as control group. The detection rate of MC in ESRD patients and control subjects was calculated and compared. Univariate analysis and multivariate logistic regression were performed in succession to determine the association between ESRD and MC, and also probe the independent MC risk factors in ESRD patients.Results. Among the 99 ESRD patients, MC was detected in 19, with a detection rate of 19.2% (95% confidence interval [CI]: 11.3%, 27.1%). In contrast, among 200 control subjects with normal renal function, MC was only detected in 1 subject, with an detection rate of 0.5% (95%CI: 0.5%, 1.5%) (ESRD vs. control: odds ratio [OR] = 47.263, 95% CI: 6.222, 358.981; p = 0.000). After adjustment of age, body mass index(BMI), albumin, hemoglobin and Charlson comorbidity index, being ESRD was still associated with the presence of MC (Odds ratio[95%CI]: 36.251[3.435, 382.559], p = 0.003). In ESRD patients, both univariate analysis (OR = 4.358, 95% CI: 1.329, 14.286; p = 0.012) and multivariate logistic regression (OR = 4.916, 95% CI: 1.462, 16.525, p = 0.010) found that past use of Rhubarb-containing TCM was the only independent risk factor of MC.Conclusion. The prevalence of MC in this cohort of ESRD patients was 19.2%, which was significantly higher than that of control with normal renal function. Past use of Rhubarb-containing traditional Chinese herbs was the only independent risk factor for the detection of MC in these ESRD patients. Our work highlights firstly that when prescribing Rhubarb-containing TCM to ESRD patients, the risk of MC development should be alerted, and also there is a need for arranging high quality, well-designed studies to examine the prevalence, etiology, impact, management and prognosis of MC in ESRD patients, especially those awaiting kidney transplantation.