The impact of chronic kidney disease (CKD) on clinical outcomes after percutaneous coronary intervention (PCI) for unprotected left main distal bifurcation lesions (ULMD) in patients with diabetes mellitus (DM) is not fully understood in drug eluting stent (DES) era. We identified 512 consecutive DM patients who underwent PCI for ULMD at New Tokyo Hospital, San Raffaele Scientific Institute and EMO-GVM Centro Cuore Columbus between January 2005 and December 2015. We analyzed according to estimated glomerular filtration rate (eGFR). Each group was defined as follows; no CKD (60 ≤ eGFR), mild CKD (45 ≤ eGFR < 60), moderate CKD (30 ≤ eGFR < 45) and severe CKD (15 ≤ eGFR < 30). The primary endpoint was target lesion failure (TLF) at 3 years. TLF was defined as a composite of cardiac death, target lesion revascularization (TLR) and myocardial infarction (MI). The rate of TLF was significantly higher in the severe CKD group than that in the other groups [Adjusted HR of severe CKD relative to the others 3.64, (1.86-7.11), p < 0.001]. Cardiac mortality was significantly higher in the severe CKD group than that in the other groups [Adjusted HR of severe CKD relative to the others 6.43, (2.19-18.9), p = 0.001]. TLR rate was comparable among 4 groups [Adjusted HR of severe CKD relative to the others 1.71, (0.60-4.82), p = 0.31]. In conclusions, among DM patients, those with severe CKD was extremely associated with worse clinical outcomes.