BACKGROUND: Chronic kidney disease (CKD) is prevalent among patients undergoing percutaneous coronary intervention (PCI) and associated with adverse cardiovascular outcomes. This study evaluated the association between moderate-to-severe CKD and major adverse cardiovascular events (MACE) after drug-eluting stent (DES) implantation using propensity score matching. METHODS: This retrospective cohort study included 200 patients undergoing PCI with DES implantation (January 2020 to January 2025). Patients were stratified by baseline eGFR: non-CKD/mild CKD (≥ 60 mL/min/1.73 m2); and moderate-to-severe CKD (< 60 mL/min/1.73 m2). After 1:1 propensity score matching, 55 pairs were analyzed. The primary endpoint was MACE, defined as all-cause death, myocardial infarction, stroke, or ischemia-driven repeat revascularization. RESULTS: After matching, patients with moderate-to-severe CKD had lower MACE-free survival (log-rank p = 0.003). Cox regression with robust sandwich standard errors clustered by matched pair showed that moderate-to-severe CKD was independently associated with higher MACE risk (HR 3.20, 95% CI 1.36-7.53; p = 0.008). Renal function deterioration (eGFR decline ≥ 30%) occurred more frequently in the CKD group (20.0% vs. 3.6%; p = 0.028). Higher rates of BARC type 2-5 bleeding and contrast-associated AKI were observed in the CKD group; contrast-associated AKI reached statistical significance in the matched analysis (p = 0.030). Sensitivity analysis using inverse probability of treatment weighting supported the robustness of these findings (MACE: p < 0.001). CONCLUSIONS: Moderate-to-severe CKD was independently associated with a higher risk of MACE and renal deterioration after DES implantation. These findings support incorporating CKD severity into post-PCI risk stratification and highlight the potential value of integrated cardiorenal monitoring and individualized management in this high-risk population.