Το perform a systematic review and meta-analysis of the available literature comparing safety and efficacy outcomes between percutaneous coronary intervention (PCI) with drug-eluting stents (DES) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease (CKD). Eligible studies included patients with eGFR<60 mL/min/1.73 m that underwent revascularization. Subgroup analyses according to DES generation and dialysis status were performed. A total of 7157 and 8156 patients were included in the CABG and PCI arms respectively across 16 studies eligible studies. Weighted mean age was 68.6 and 63.8 years for the CABG and PCI arms respectively. Mean follow-up time was 3.2 and 2.9 years respectively. Compared to CABG, PCI was associated with increased risk for all-cause mortality (HR: 1.28, 95% CI: 1.13, 1.46; P<.01), cardiac mortality (HR: 1.59, 95% CI: 1.13, 2.23; P=.01), myocardial infarction (MI) (HR: 1.89, 95% CI: 1.43, 2.49; P<.01) and repeat revascularization (HR: 2.97, 95% CI: 2.20, 3.97; P<.01). Risk for stroke was lower (HR: 0.64, 95% CI: 0.50, 0,81; P<.01) in the PCI group. These results were unchanged when 1 or 2 DES were used. A subgroup analysis showed no difference in all-cause mortality for DES PCI vs. CABG in dialysis patients (HR: 1.11, 95% CI: 0.71, 1.73; P=.65). In patients with CKD, PCI is associated with higher risk of mortality, MI and repeat revascularization compared with CABG and regardless of DES generation. Risk of stroke is higher with CABG. Type of revascularization had no impact on survival of dialysis patients.Copyright © 2020. Published by Elsevier Inc.