Purpose <p>To investigate the impact of chronic kidney disease (CKD) on perioperative and long-term outcomes of pulmonary resection in patients with lung cancer.</p> Methods <p>Data from 331 patients who underwent pulmonary surgery for non-small-cell Lung cancer associated with CKD between 2016 and 2020 were analyzed. Patients were categorized based on preoperative reduced renal function (estimated glomerular filtration rate [eGFR] &lt; 45&#xa0;mL/min/1.73m² [CKD grade ≥ G3b]). Patients with (n = 20) and without (n = 311) CKD were compared based on their clinicopathological characteristics and outcomes.</p> Results <p>Grades ≥ 2 and ≥ 3 postoperative pulmonary complications (PPCs) in the Clavien-Dindo classification and postoperative air leaks were common in the CKD group (p = 0.015, 0.005, and 0.025, respectively). The duration of drainage and hospital stay was long (p = 0.003, and p = 0.040, respectively). Kaplan–Meier curves showed a poor prognosis with regard to the overall survival (p = 0.022) and disease-free survival (p = 0.018) in the CKD group. A multivariate analysis confirmed that CKD with an eGFR &lt; 45&#xa0;mL/min/1.73 m² was a significant risk factor for grade ≥ 3 PPCs (p = 0.037).</p> Conclusions <p>CKD with an eGFR &lt; 45&#xa0;mL/min/1.73 m² involves various perioperative risks; therefore, care must be taken in intraoperative and perioperative management, and long-term collaboration with a nephrologist even before surgery is necessary.</p>