BACKGROUND: Patients with chronic kidney disease (CKD) are more vulnerable to tuberculosis (TB) because of weakened immune systems, which is a serious health risk, especially in low-to-middle-income nations. EPIDEMIOLOGY: CKD patients have a 6.9 to 52.5 times higher risk of developing TB, with dialysis patients at even greater risk. PATHOGENESIS: Impaired cell-mediated immunity, malnutrition, Vitamin-D deficiency, and Zinc deficiency contribute to TB susceptibility in CKD patients. DIAGNOSTIC CHALLENGES: Atypical symptoms, nonspecific presentation, and limited diagnostic tools hinder TB diagnosis in CKD patients. MANAGEMENT: Collaborative care and tailored treatment are essential. Anti-TB therapy requires dosing adjustments, careful monitoring, and consideration of comorbid conditions. CONCLUSION: TB in CKD patients presents a complex clinical picture, requiring heightened awareness and multidisciplinary collaboration. Further research is needed to develop CKD-specific TB screening tools, optimal treatment regimens, and improved understanding of TB-CKD pathophysiology.