There is a scarcity of data on clinical outcomes after intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) in patients with multivessel disease and chronic kidney disease (CKD). The Optimal Intravascular Ultrasound (OPTIVUS)-Complex PCI study multivessel cohort was a prospective multicenter single-arm trial enrolling 1,015 patients who underwent multivessel IVUS-guided PCI including left anterior descending coronary artery target with an intention to meet the prespecified OPTIVUS criteria for optimal stent expansion. We compared the clinical outcomes between patients with and without CKD. The primary end point was a composite of death, myocardial infarction, stroke, or any coronary revascularization. There were 528 patients (52.0%) without CKD (estimated glomerular filtration rate [eGFR] ≥60 ml/min/1.73 m