Analysis using the Kyoto Encyclopedia of Genes and Genomes (KEGG) prediction module revealed significant differences in metabolic pathways between the two groups, including alanine, aspartate and glutamate metabolism; cysteine and methionine metabolism; pyrimidine metabolism; carbon metabolism; ABC transporters; and oxidative phosphorylation pathways.<h4>Conclusions</h4>EPO-induced gut dysbiosis, particularly changes in <i>Akkermansia, Lactobacillus,</i> and <i>Alistipes</i> abundance, may contribute to AAA formation via inflammation, oxidative stress, and metabolic dysfunction. Here, EPO is linked to triple-A syndrome.