Background chronic kidney disease (CKD) is a strong predictor of mortality and subsequent cardiac events after percutaneous coronary intervention.The safety and efficacy of drug-eluting stent (DES) in this population have not been adequately evaluated.We conducted a meta-analysis to compare the clinical outcomes of DES and bare metal stent (BMS) use in patients with CKD.Methods and Results Major electronic information sources were searched for studies comparing outcomes with DES and BMS use among patients with CKD.Data from 65088 patients in 2 post-hoc analyses from randomized controlled trials and 18 observational studies were included.Compared with BMS, DES were associated with significant reductions in mortality (OR, 0.86; 95% CI, 0.82 to 0.91; p <0.00001), repeat revascularization (OR, 0.58; 95% CI, 0.46 to 0.73; p <0.0001), MI (OR, 0.85; 95% CI, 0.79 to 0.92; p <0.0001), and major adverse cardiovascular events (OR, 0.61; 95% CI, 0.49 to 0.76; p <0.0001).No difference in the likelihood of stent thrombosis between the two groups was observed (OR, 0.90; 95% CI, 0.48 to 1.71; p =0.76).Subgroup analysis showed that the benefit of DES versus BMS on mortality was restricted to unadjusted, retrospective observational studies, and studies with short-term follow-up period (<2 year).Conclusions Our meta-analysis suggests that the use of DES in CKD patients is associated with decreased repeat revascularization, MI and MACE without increasing the risk of mortality and stent thrombosis.The true effect of DES versus BMS on mortality needs to be confirmed by further investigations.